Radiofrequency Treatment for Lumbar Osteoarthritis (Facet Joint Denervation)

Transcript translated from Turkish (video audio remains in Turkish)

Hello everyone, I am Dr. Mehmet Levent Deniz, a specialist in brain, nerve and spine surgery. I will explain the medial branch denervation treatment that I use for facet syndrome, colloquially known as lumbar osteoarthritis.

We perform medial branch denervation for facet syndrome, colloquially known as lumbar osteoarthritis, under imaging guidance and local anaesthesia. We reach the medial branches using fluoroscopy. A medial branch is a nerve that carries pain signals from the facet joints and lets us feel that pain.

Radiofrequency electrodes are then inserted. A computer-controlled device connected to the electrodes applies controlled heat to these nerves. The aim is to interrupt their nerve conduction and thus the transmission of pain.

The procedure takes an average of 25 to 30 minutes. Patients are discharged after about 30 minutes of observation.

I wish you all pain-free and happy days. Stay well.

What Is Radiofrequency Treatment?

Radiofrequency treatment (facet joint denervation) is an algology procedure (interventional pain treatment) used for chronic facet-joint-related lower back pain [2].

How Does Radiofrequency Treatment Work?

It reduces pain transmission by applying heat to the nerve that carries pain signals from a facet joint.

• Mechanism: The nerve carrying pain signals from the facet joints to the brain is called the medial branch. In patients whose diagnostic medial branch block supports a facet origin, a computer-controlled device applies heat to this nerve, creating a small thermal lesion that reduces pain transmission.

Who Can Receive Radiofrequency Treatment?

It is used for patients whose diagnostic block confirms that the pain comes from a facet joint. The procedure is used for pain from facet syndrome (lumbar osteoarthritis) and for facet-related pain accompanying spinal stenosis, together with an epidural injection when needed. Radiofrequency does not widen the canal; in stenosis it targets only the accompanying facet-related pain.

How Is Radiofrequency Treatment Performed?

It takes 20–30 minutes in an operating theatre under local anaesthesia and fluoroscopic (live imaging) guidance.

• Preparation and Anaesthesia: No extensive preparation is required. It is performed entirely under local anaesthesia without putting the patient to sleep.
• Duration: Depending on the number of levels and sides treated, it takes 20–30 minutes.
• Discharge: After approximately 1–2 hours of observation, our patients walk home the same day. Avoiding heavy exertion for the first 24–48 hours is sufficient; bed rest is unnecessary.

Does Radiofrequency Denervation Relieve Lower Back Pain? (Success Rates)

Yes: in the reference study, 87% of patients selected by diagnostic medial branch block reported at least 60% pain reduction for 12 months, and 60% reported at least 90% reduction [1]. In appropriately selected patients, this procedure provides lasting pain control. These figures apply to patients selected through a diagnostic block. In good responders, pain reduction lasts up to 12 months [2]; the effect has also been shown not to be attributable to placebo [3]. Radiofrequency was superior to placebo in the short, medium and long term [5].

Success depends on patient selection: effects are more pronounced in those responding well to a diagnostic block [2, 4], while a broad review found the average effect small [7]. Favourable results have been reported in block-selected patients [8].

What Are the Risks and Side Effects of Radiofrequency Treatment?

Risk is low: a safety study found a minor complication rate of 1.0% per lesion and no infections, new weakness or new sensory loss [6]. The procedure targets a sensory nerve, while motor nerves are protected through stimulation testing, so serious neurological complications are rare. These findings came from 616 lesion sites across 116 procedures; minor complications were pain at the treated site lasting more than two weeks and nerve-related pain lasting less than two weeks.

🩺 Physician’s Insight & Clinical Experience

“As a surgeon who frequently uses radiofrequency treatment, I can say that this method gives quite good results in the right patient. The main cause of unsuccessful outcomes is an incorrect diagnosis. Symptoms of other conditions, particularly spondylolisthesis, closely resemble those of facet disease. Success therefore depends on careful patient selection and a diagnostic block before the procedure.”

Frequently Asked Questions

What Is Radiofrequency Treatment, and How Is It Performed?

It is an incision-free procedure that reduces pain transmission by applying heat to the facet joint’s pain nerve under fluoroscopic guidance; it takes 20–30 minutes.

What Is the Success Rate of Radiofrequency Treatment?

Of patients selected through a diagnostic block, 87% reported at least 60% pain reduction for 12 months [1]. Success depends on selection, with a more pronounced effect in good responders to the block [2, 4].

Does Radiofrequency Treatment Have Risks or Side Effects?

Yes, but they are low: a safety study found a 1.0% minor complication rate per lesion and no infection or new nerve injury [6]. Temporary pain at the treatment site is most common; motor nerves are protected using stimulation testing.

How Long Does Radiofrequency Treatment Take?

Depending on the number of levels and sides treated, the procedure takes 20–30 minutes.

How Long Must I Stay in Hospital After Radiofrequency Treatment?

Patients walk home the same day after approximately 1–2 hours of observation.

What Should I Do After Radiofrequency Treatment, and When Can I Return to Work?

Avoiding heavy exertion on the day of treatment and the following day is sufficient. With no incision or stitches, our patients return to work and daily life within 1–2 days; bed rest is not needed.

What Is the Diagnostic Block (Test Injection) Before Radiofrequency Treatment?

The diagnostic block is a test injection that shows whether pain comes from the facet joint. Before radiofrequency, a very small amount of local anaesthetic is injected beside the pain-carrying medial branch nerve (medial branch block) to test whether the joint is the source. If pain temporarily improves substantially, radiofrequency is considered likely to succeed.

When Does Radiofrequency Treatment Take Effect?

The effect usually becomes clear within 2–3 weeks. Some patients improve immediately; temporary pain at the treatment site may obscure the result during the first days.

How Long Does Radiofrequency Treatment Last?

In suitable patients, its effect lasts for up to 12 months [2].

How Does Radiofrequency Facet Denervation Differ from Laser Treatment?

They target different problems: radiofrequency targets the facet joint’s pain nerve, while laser is applied to the disc in selected disc conditions. They are therefore not alternatives to one another.

Can Radiofrequency Also Be Used for Cervical Osteoarthritis?

Yes, it is also used for chronic neck pain originating in the cervical facet joints. Because cervical anatomy differs, patient selection and technique are assessed separately.

Which Specialist Performs Radiofrequency Treatment (Facet Denervation) in Istanbul?

One of the physicians performing radiofrequency treatment (facet joint denervation) in Istanbul is M. Levent Deniz, MD, a specialist in neurosurgery.

How Much Does Radiofrequency Treatment (Facet Denervation) Cost?

As treatment costs vary according to the patient and hospital conditions, a definite fee can only be determined after examination and review of imaging.

References

1. Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine (Phila Pa 1976). 2000;25(10):1270-1277. PMID: 10806505.
2. Lee CH, Chung CK, Kim CH. The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials. Spine J. 2017;17(11):1770-1780. PMID: 28576500.
3. Nath S, Nath CA, Pettersson K. Percutaneous lumbar zygapophysial (Facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: a randomized double-blind trial. Spine (Phila Pa 1976). 2008;33(12):1291-1297. PMID: 18496338.
4. Janapala RN, Manchikanti L, Sanapati MR, et al. Efficacy of Radiofrequency Neurotomy in Chronic Low Back Pain: A Systematic Review and Meta-Analysis. J Pain Res. 2021;14:2859-2891. PMID: 34531682.
5. Láinez Ramos-Bossini AJ, Jiménez Gutiérrez PM, Ruiz Santiago F. Efficacy of radiofrequency in lumbar facet joint pain: a systematic review and meta-analysis of placebo-controlled randomized controlled trials. Radiol Med. 2024;129(5):794-806. PMID: 38512629.
6. Kornick C, Kramarich SS, Lamer TJ, Todd Sitzman B. Complications of lumbar facet radiofrequency denervation. Spine (Phila Pa 1976). 2004;29(12):1352-1354. PMID: 15187637.
7. Truong KMTL, Maas E, Rasmussen MM, Ostelo R, Hurri H, van Tulder MW. Current evidence on radiofrequency denervation for chronic low back pain: a systematic review and meta-analysis. BMJ Open. 2026;16(7):e105106. PMID: 42463214.
8. Manchikanti L, Knezevic E, Knezevic NN, Sanapati M, Kaye AD, Singh V, Pasupuleti R, Prajapati MS, Boddu N, Hirsch JA. Effectiveness of Radiofrequency Ablation in Managing Chronic Axial Spinal Pain of Facet Joint Origin: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Physician. 2026;29(3):205-240. PMID: 42263300.

• 👨‍⚕️ Author and medical reviewer of this content: M. Levent Deniz, MD – Neurosurgery Specialist
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.