PONOS · Interventional pain medicine
Cervical
radiofrequency
A targeted pathway for facet joint pain and radicular pain.
Diagnosis guides treatment
Two types of pain, two different techniques
“Cervical radiofrequency” does not describe a single treatment. In the PONOS pathway, Dr Evangelos Panagiotakos first identifies the structure responsible for the symptoms and considers whether a targeted procedure may help when conservative care is insufficient.
01 · Facet joint pain
Thermal RF of the medial branches
The small joints at the back of the neck can be a source of cervical pain. This procedure creates a controlled thermal lesion of the medial branches that carry pain signals from these joints. It is denervation, rather than pulsed RF.
Selection requires clinical assessment and a significant response to a targeted local anaesthetic block. Osteoarthritis seen on an MRI scan does not, by itself, establish an indication.[1]
02 · Radicular pain
PRF of the dorsal root ganglion
When pain and tingling radiate into the arm or hand, possible radiculopathy needs assessment. In selected cases, pulsed radiofrequency (PRF) of the dorsal root ganglion may be considered for neuromodulation, without aiming to create a thermal lesion of the nerve root.
The evidence is more limited than for facet denervation. Indications, alternatives and expectations should be discussed individually.[2]
Before radiofrequency
Understanding the source of pain
- Consultation and neurological examination. The distribution of symptoms, strength, sensation and reflexes help distinguish joint, muscular and radicular pain.
- Imaging interpreted in its clinical context. MRI and other investigations are considered alongside the patient’s history. An imaging abnormality is not automatically a treatment target.
- A targeted diagnostic injection. In the facet pathway, a medial branch local anaesthetic block helps select the target. Outpatient assessment at PONOS may include ultrasound-guided diagnostic injections, documenting changes in the usual pain and in the movements that provoke it.[1]
- A shared decision. The response to the block, symptom duration, previous treatments and functional goals guide the choice of procedure.
When a different pathway is needed
Radiofrequency does not remove a herniated disc or decompress the spinal cord. Progressive weakness, new walking difficulties or loss of hand dexterity require prompt assessment. A pain procedure must not delay indicated surgery. Predominantly muscular pain may also need a different treatment approach.
The procedure
Image guidance and targeted checks
Cervical RF is performed in a dedicated setting using sterile technique and local anaesthesia. For facet treatment, fluoroscopy allows the position of the needles to be checked against bony landmarks.[3]
The planned checks, including sensory and motor stimulation, are performed before lesioning. The aim is to obtain responses consistent with the target and exclude inappropriate motor responses suggesting nerve root involvement. Contraction of the paraspinal muscles may be expected. These checks reduce risk without eliminating it.[1]
Ganglion PRF follows a different protocol, with image-guided positioning and checks appropriate to working close to a nerve root. Contrast medium and any accompanying medication are selected according to the technique and indication.[4]
Benefits, recovery and safety
Measuring the benefit
In selected patients, facet denervation can provide sustained pain relief. Responses vary and pain may return. The outcome should also be assessed through sleep, movement and medication requirements.[5]
Radiofrequency does not reverse degenerative changes. Functional rehabilitation and treatment of associated muscular pain remain part of care.
Understanding the risks
Soreness, stiffness or temporary sensory changes may occur; bleeding and infection are also possible.[3] Procedures near the cervical nerve roots may cause nerve injury and, very rarely, serious vascular or spinal cord complications.[4]
A new or progressive neurological deficit after treatment requires urgent assessment. Consent is discussed in relation to the specific technique proposed.
PONOS clinical practice
Two cases, two pathways
Clinical cases describe individual outcomes and do not predict other patients’ results. The following case reports are in Italian.
Frequently asked questions
Does cervical RF always create a lesion?
Thermal RF of the medial branches creates a controlled lesion. PRF of the dorsal root ganglion is intended for neuromodulation. The procedures have different targets and indications.
Does a positive anaesthetic block guarantee success?
No. It is an important part of selecting facet treatment and must be interpreted alongside the examination and other clinical findings.
Can it help after cervical fusion?
It may be considered in some cases, after identifying the cause of persistent symptoms and excluding problems requiring a different treatment. Previous surgery makes individual planning particularly important.
Is relief immediate and permanent?
Not necessarily. Improvement can be gradual and its duration varies. Follow-up helps distinguish residual pain, any procedure-related effects and the clinical benefit.
Will I need to stay overnight?
Treatment is usually provided as a day case, with discharge after observation if appropriate. Individual instructions cover an escort home and return to normal activities.
Key references
- Hurley RW et al. Consensus practice guidelines on interventions for cervical spine (facet) joint pain. Reg Anesth Pain Med, 2022. Full text.
- Van Zundert J et al. Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: a double blind sham controlled randomized clinical trial. Pain, 2007;127:173–182. PubMed.
- Royal Berkshire NHS. Cervical facet joint radiofrequency denervation. Patient information, 2024.
- Royal Berkshire NHS. Pulsed radiofrequency of a cervical nerve root. Patient information, 2024.
- Lord SM et al. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med, 1996;335:1721–1726. PubMed.