Why we do not advocate Radiofrequency Ablation. 

There is a very important muscle deep in your back called the multifidus. It is a very important muscle but very few people have ever heard of. Its main function is to stabilize your back and help take the pressure off the disc.

MULTIFIDUS MUSCLE AND ITS FUNCTION.

This muscle fills up the deepest layer of the groove on either side of the spinous processes of the vertebrae, from the sacrum all the way up to the top of your spine. Its function is to stabilize the back. The multifidus muscle helps to take the pressure off the vertebral disc so that the body weight can be well distributed along the spine.

INNERVATION OF THE MULTIFIDUS.

There is electrophysiological evidence in the human lumbar spine that the medial branch of the lumbar root innervates the multifidus muscle at multiple levels, i.e., the lumbar multifidus muscle is polysegmentally innervated. This so called medial branch nerve of the lumbar roots is the nerve that is damaged on purpose when a radiofrequency ablation procedure is performed by your interventional pain doctor.

CONSEQUENCES OF REDIOFREQEUNCY ABLATION.

Damaging the innervation of this muscle with radiofrequency ablation will eventually worsen the pain. In the MRI of the lumbar spine in chronic back pain patients, atrophy of this important muscle is frequently seen. When these muscles atrophy the spine becomes unstable and more wear and tear happens in the disc, nerve, and joints when the patient is active. This leads to increase in pain. See the following videos:

Normal walking.- https://youtu.be/4TMpAdTnBck

Segmental instability.- https://youtu.be/RJIPFIoOaFY

ALTERNATIVES TREATMENTS FOR PAINFUL FACET JOINTS OF THE LOWER?

In our practice, radiofrequency ablation for lower lumbar facet pain is not used. RIP. Injection procedures of the lower back such as proliferative therapy with hypertonic glucose, autologous cell therapies and plasma rich in platelets, have replaced this technique and we obtain excellent results comparable to or better than radiofrequency ablation.