What is a Radiofrequency Ablation?

Pain-Doctor-Radiofrequency-Ablation-Procedure-7_copy

 

Radiofrequency Ablation or RFA is a minimally invasive procedure that can help manage and provide lasting relief to multiple pain syndromes, the most common of these is arthritic facet joints. The RFA is very safe and can be used for the Cervical, thoracic, and lumbar parts of the spine.  The RFA is a technique that uses heat to disable sensory nerves which are the pain-transmitting nerves in the spine.  When the heat is applied it shuts off the transmission of pain signals to the brain.

How does a Radiofrequency Ablation relieve my pain?

The Radiofrequency ablation is able to relieve pain by using heat to disable the pain-transmitting nerves, when the sensory nerves undergo this heat treatment they stop transmitting pain to the brain.

What Can I expect during and after this procedure?

During:

  • The procedure usually takes 15-30 minutes
  • The patient lies flat on his/her abdomen
  • The area of the injection is cleaned and numbed with lidocaine
  • The patient is put under with a light sedation
  • Using live X-Ray (fluoroscopy) for guidance, the physician inserts an electrode towards the (facet joint) medial or lateral nerve branch (sacroiliac joint)
  • Once placement is confirmed, a high-frequency electrical current is passed through the electrode, heating up and burning the sensory nerve.

After:

  • The patient is usually monitored for 15-30 minutes before being discharged.
  • The patient must have a driver
  • Patients are usually asked to rest the day of the injections
  • Normal activities can be typically resumed within 24-48 hours following the injection
  • Patients can start feeling relief 2-4 weeks after the procedure and in some cases it can take up to 6-8 weeks to feel the full effects of the RFA.

Better than Laser Spine Surgery!

- Smaller Needle

- Less Invasive

- Covered by most insurance

 

Dr. Asraf Hanna performs an RFA surgery on a patient at the Florida Spine Institute in Clearwater, Florida

Prior to seeing Dr. Hanna, Mary Sullivan had immense pain and could not move her neck. Dr. Hanna performed a Radiofrequency Ablation treatment that reduced Mary’s pain and allowed her to move freely and gave her mobility.

Additional Info on RFA

Tumors

RFA may be performed to treat tumors in the lung,[4][5][6] liver,[7] kidney, and bone, as well as other body organs less commonly. Once the diagnosis of tumor is confirmed, a needle-like RFA probe is placed inside the tumor. The radiofrequency waves passing through the probe increase the temperature within tumor tissue and results in destruction of the tumor. RFA can be used with small tumors, whether these arose within the organ (primary tumors) or spread to the organ (metastases). The suitability of RFA for a particular tumor depends on multiple factors.

RFA can usually be administered as an outpatient procedure, though may at times require a brief hospital stay. RFA may be combined with locally-delivered chemotherapy to treat hepatocellular carcinoma (primary liver cancer). A method currently in phase III trials uses the low-level heat (hyperthermia) created by the RFA probe to trigger release of concentrated chemotherapeutic drugs from heat-sensitive liposomes in the margins around the ablated tissue as a treatment for Hepatocellular carcinoma (HCC).[8] Radiofrequency ablation is also used in pancreatic cancer and bile duct cancer.[9]

Pain Management

RFA, or rhizotomy, is sometimes used to treat severe chronic pain in the lower (lumbar) back, where radio frequency waves are used to produce heat on specifically identified nerves surrounding the facet joints on either side of the lumbar spine. By generating heat around the nerve, its ability to transmit pain signals to the brain is destroyed, thus ablating the nerve. The nerves to be ablated are identified through injections of local anesthesia (such as lidocaine) prior to the RFA procedure. If thelocal anesthesia injections provide temporary pain relief, then RFA is performed on the nerve(s) that responded well to the injections. RFA is a minimally invasive procedure that can usually be done in day-surgery clinics, going home shortly after completion of the procedure. The patient is awake during the procedure, so risks associated with general anesthesia are avoided. An intravenous line may be inserted so that mild sedatives can be administered. The major drawback for this procedure is that nerves regenerate over time, so the pain relief achieved lasts for only a short duration (6–24 months[19]) in most patients.

Varicose Veins

Radiofrequency ablation is a minimally invasive procedure used in the treatment of varicose veins. It is an alternative to the traditional stripping operation. Under ultrasound guidance, a radiofrequency catheter is inserted into the abnormal vein and the vessel treated with radio-energy, resulting in closure of the involved vein. Radiofrequency ablation is used to treat the great saphenous vein, the small saphenous vein, and the perforator veins. The latter are connecting veins that transport blood from the superficial veins to the deep veins. Branch varicose veins are then usually treated with other minimally invasive procedures, such as ambulatory phlebectomysclerotherapy, or foam sclerotherapy. Currently, the VNUS ClosureRFSstylet is the only device specifically cleared by FDA for endovenous ablation of perforator veins.[14]

It should be pointed out that the possibility of skin burn during the procedure is very small, because the large volumes (500 cc) of dilute Lidocaine (0.1%) tumescent anesthesia injected along the entire vein prior to the application of radiofrequency provide a heat sink that absorbs the heat created by the device. Early studies have shown a high success rate with low rates of complications.

Obstructive Sleep Apnea

RFA was first studied in obstructive sleep apnea (OSA) in a pig model.[15] RFA has been recognized as a somnoplasty treatment option in selected situations by theAmerican Academy of Otolaryngology[15] but was not endorsed for general use in the American College of Physicians guidelines.[16]

The clinical application of RFA in obstructive sleep apnea is reviewed in that main article, including controversies and potential advantages in selected medical situations. Unlike other electrosurgical devices,[17] RFA allows very specific treatment targeting of the desired tissue with a precise line of demarcation that avoids collateral damage, which is crucial in the head and neck region due to its high density of major nerves and blood vessels. RFA also does not require high temperatures. However, overheating from misapplication of RFA can cause harmful effects such as coagulation on the surface of the electrode, boiling within tissue that can leave “a gaping hole”, tears, or even charring.[18]

Cardiology

Radiofrequency energy is used in heart tissue or normal parts to destroy abnormal electrical pathways that are contributing to acardiac arrhythmia. It is used in recurrent atrial flutter (Afl), atrial fibrillation (AF), supraventricular tachycardia (SVT), atrial tachycardiaMultifocal Atrial Tachycardia (MAT) and some types of ventricular arrhythmia. The energy-emitting probe (electrode) is at the tip of a catheter which is placed into the heart, usually through a vein. This catheter is called the ablator. The practitioner first “maps” an area of the heart to locate the abnormal electrical activity (electrophysiology study) before the responsible tissue is eliminated. Ablation is now the standard treatment for SVT and typical atrial flutter and the technique can also be used in AF, either to block the atrioventricular node after implantation of a pacemaker or to block conduction within theleft atrium, especially around the pulmonary veins. In some conditions, especially forms of intra-nodal re-entry (the most common type of SVT), also called atrioventricular nodal reentrant tachycardia or AVNRT, ablation can also be accomplished bycryoablation (tissue freezing using a coolant which flows through the catheter) which avoids the risk of complete heart block – a potential complication of RF ablation in this condition. Recurrence rates with cryoablation are higher, though.[10] Microwave ablation, where tissue is ablated by the microwave energy “cooking” the adjacent tissue, and ultrasonic ablation, creating a heating effect by mechanical vibration, or laser ablation have also been developed but are not in widespread use.

In 2004, former British prime minister Tony Blair underwent RF catheter ablation for recurrent atrial flutter.[11][12]

In AF, the abnormal electrophysiology can also be corrected surgically. This procedure, referred to as the “Cox maze procedure”, is mostly performed concomitantly with cardiac surgery.

A new and promising indication for the use of RF technology has made news in the last few years. Hypertension (high blood pressure) is a very common condition, with about 1 billion people over the world, nearly 75 million in the US alone. Complications of inadequately controlled hypertension are many and have both individual and global impact. Treatment options include medications, diet, exercise, weight reduction and meditation. Inhibition of the neural impulses that are believed to cause or worsen hypertension has been tried for a few decades. Surgical sympathectomy has helped but not without significant side effects. Therefore, the introduction of non-surgical means of renal denervation with RF ablation catheter was enthusiastically welcomed. Although, the initial use of RF-generated heat to ablate nerve endings in the renal arteries to aid in management of ‘resistant hypertension’ were encouraging, the most recent phase 3 studying looking at catheter-based renal denervation for the treatment of resistant hypertension failed to show any significant reduction in systolic blood pressure.[13]

Other Uses

RFA is also used in radiofrequency lesioning, for vein closure in areas where intrusive surgery is contraindicated by trauma, and in liver resection to control bleeding (hemostasis) and facilitate the transection process.

This process has also been used with success to treat TRAP sequence in multiple gestation pregnancies. This is becoming the leading method of treatment with a higher success rate for saving the ‘pump’ twin in recent studies than previous methods including laser photocoagulation. Due to the rarity of this complication, its correct diagnosis statistics are not yet reliable.

RFA is being investigated to treat uterine fibroids. A system developed by Halt Medical Inc. uses the heat energy of radio frequency waves to ablate the fibroid tissue. The device obtained FDA approval in 2012.[25][26] The device is inserted via a laparoscopic probe and guided inside the fibroid tissue using an ultrasound probe.

RFA is also used in the treatment of Morton’s neuroma[27] where the outcome appears to be more reliable than alcohol injections.[28]

  1.  http://www.americanheart.org/presenter.jhtml?identifier=4682
  2.  http://www.mayoclinic.org/radiofrequency-ablation
  3.  March 2008 – Radiofrequency ablation (RFA) gives lung cancer patients two more years
  4.  NHS, June 2008 – Radiofrequency ablation for lung cancer
  5.  Daily Telegraph – June 2008 – Lung cancer radiation treatment offers new hope
  6.  BBC News- 16 January 2009 – Liver tumours ‘microwaved away’
  7.  Phase 3 Study of ThermoDox With Radiofrequency Ablation (RFA) in Treatment of Hepatocellular Carcinoma (HCC)
  8.  Hadjicostas, P.; Malakounides, N.; Varianos, C.; Kitiris, E.; Lerni, F.; Symeonides, P. (2006). “Radiofrequency ablation in pancreatic cancer”HPB: Official Journal of the International HepatoPancreato Biliary Association 8 (1): 61–64. doi:10.1080/13651820500466673PMC 2131369PMID 18333241.
  9. Deisenhofer I, Zrenner B, Yin YH, et al. Cryoablation Versus Radiofrequency Energy for the Ablation of Atrioventricular Nodal Reentrant Tachycardia (the CYRANO Study) : Results From a Large Multicenter Prospective Randomized Trial. Circulation 2010, 122:2239-2245
  10. http://www.theheart.org/article/214333.do
  11. “Blair sails through surgery, but house deal faces probe”The Sun-Herald (Sydney). October 3, 2004.
  12. Bhatt DL, Kandzari KE, O’Neill WW, et al. A Controlled Trial of Renal Denervation for Resistant Hypertension (SYMPLICITY HTN-3 Trial). N Engl J Med 2014; 370:1393-1401
  13. Endovenous ablation of perforator veins
  14. “Submucosal Ablation of the Tongue Base for OSAS”American Academy of Otolaryngology- Head and Neck Surgery. Retrieved 29 October 2013.
  15. Qaseem, A; Holty, JE; Owens, DK; Dallas, P; Starkey, M; Shekelle, P; for the Clinical Guidelines Committee of the American College of, Physicians (Sep 24, 2013). “Management of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians.”. Annals of Internal Medicinedoi:10.7326/0003-4819-159-7-201310010-00704PMID 24061345.
  16. Bashetty, Kusum; GururajNadigSandhyaKapoor (19 November 2009). “Electrosurgery in aesthetic and restorative dentistry: A literature review and case reports”Journal of Conservative Dentistry 12 (4): 139–144. doi:10.4103/0972-0707.58332PMC 2879725PMID 20543922.
  17. Eick, Olaf J (1 July 2002). “Temperature Controlled Radiofrequency Ablation”Indian Pacing Electrophysiol. 3 2 (3): 66–73. PMC 1564057PMID 17006561. Retrieved1 November 2013.
  18. RADIOFREQUENCY ABLATION FOR BACK PAIN
  19. Ganz R, Utley D, Stern R, et al. Complete Ablation of Esophageal Epithelium Using a Balloon-based Bipolar Electrode. Gastrointestinal Endoscopy 2004; 60:1002-10.
  20. Fleischer DE, Overholt, BF, Sharma VK, et al. (2010). “Endoscopic radiofrequency ablation for Barrett’s esophagus: 5-year outcomes from a prospective multicenter trial”. Endoscopy 42 (10): 781-9.
  21. Shaheen NJ, Sharma, P, Overholt, BF, et al. (2009). “Radiofrequency Ablation in Barrett’s Esophagus with Dysplasia”. New England Journal of Medicine 360 (22): 2277-88.
  22. Shaheen NJ, Overholt, BF, Sampliner, RE et al. (2011). “Durability of Ablation in Barrett’s Esophagus with Dysplasia”. Gastroenterology 141 (2): 460-8.
  23. vanVilsteren FG, Pouw RE, Seewald, S et al. “Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett’s oesophagus with high grade dysplasia or early cancer: a multicentrerandomised trial”. Gut 60: 765-73.
  24. [Halt Medical Inc. http://acessaprocedure.com]
  25. [1]
  26. Chuter, G.S., Chua, Y.P., Connell, D.A., Blackney, M.C., 2013. Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton’s) neuroma. Skeletal radiology 42, 107-111.
  27. Gurdezi, S., White, T., Ramesh, P., 2013. Alcohol injection for Morton’s neuroma: a five-year follow-up. Foot & ankle international 34, 1064-1067.

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