PONOS · Spinal procedures
Lumbar facet radiofrequency denervation
Targeted thermal denervation for facet joint pain, following a positive ultrasound-guided local anaesthetic block.
Targeting pain from the facet joints
The facet joints are small joints at the back of the spine that guide and support spinal movement. When they become a source of pain, they can contribute to persistent low back pain, sometimes radiating to the buttocks or upper thighs. Pain may increase when standing, extending the back or rotating the trunk. These features help guide the assessment, but cannot establish the source of pain on their own.
Lumbar facet radiofrequency denervation targets the medial branches of the dorsal rami that carry pain signals from the joints; treatment for the L5–S1 joint also includes the L5 dorsal ramus. The PONOS pathway described on this page always uses thermal radiofrequency: controlled heat creates a targeted lesion of the nerve.
Before surgery: a positive block in the outpatient clinic
Patient selection takes place during the outpatient pathway. Before radiofrequency treatment is scheduled, an ultrasound-guided local anaesthetic test injection is performed, targeting the structures identified during the specialist assessment. Pain and normally painful movements are compared before and after the block.
Identify the facet-related component
The clinical history, examination and available reports are considered together, while checking for other possible causes of low back pain.
Check for meaningful relief
Improvement is assessed while the anaesthetic is active, including by repeating activities or movements that usually cause pain.
Schedule denervation
The patient comes to theatre after a positive test has already been completed and its response assessed for consistency with the clinical findings.
A positive test supports the indication and helps select patients; it does not guarantee the result of radiofrequency treatment. In the literature, medial branch blocks have greater prognostic value than intra-articular injections alone. The target of the block, the extent of relief and its duration should therefore be documented.
How the procedure is performed
Radiofrequency treatment is performed in an operating theatre, as day surgery, under fluoroscopic guidance. The patient usually lies face down. Following sterile preparation and local anaesthesia, needle electrodes are positioned at the nerve targets at the selected levels.
Fluoroscopic checks
X-ray images allow the clinician to check the bony landmarks and electrode position in the required views.
Sensory and motor stimulation
A positive sensory response consistent with the target is sought. Motor testing must be negative for unwanted nerve root responses in the lower limbs.
Controlled thermal lesioning
After these checks, thermal radiofrequency is delivered using parameters appropriate to the technique and targets. Multiple levels can be treated when indicated.
Day surgery: home on the same day
No overnight stay is planned. The procedure is followed by a period of observation and, when clinically appropriate, discharge on the same day.
Before admission, you will receive instructions on preparation, any fasting requirements, arranging an accompanying adult and resuming activities. All medicines, including anticoagulants and antiplatelet agents, must be reported: their management is agreed individually. Do not change them yourself.
What to expect after radiofrequency treatment
During the first few days, you may experience soreness at the needle sites, local discomfort or a temporary increase in pain. Relief may develop gradually over the following weeks: the immediate effect of the local anaesthetic is not the same as the outcome of denervation.
The aim is to reduce facet-related pain and support movement, daily activities and functional recovery. Outcomes and their duration vary. Nerves can recover their function over time; if pain returns after meaningful relief, repeat treatment may be considered following reassessment.
Denervation does not remove osteoarthritis or correct spinal instability. Follow-up and an appropriate movement programme remain part of treatment.
Safety and risk management
Accurate positioning, fluoroscopy and stimulation testing contribute to safety. Complications remain possible, including bleeding, infection, neuritis and, rarely, nerve injury. Expected benefits, limitations and risks are discussed in relation to each individual situation.
New weakness, bladder or bowel disturbances, fever or severe rapidly worsening pain require prompt medical assessment.
Frequently asked questions
Is this pulsed radiofrequency?
No. The facet procedure described here uses thermal lesioning. Pulsed radiofrequency has different indications and targets and is not presented as an equivalent alternative in this pathway.
Must the anaesthetic block already have been performed?
Yes. In the PONOS pathway, treatment is scheduled after a positive outpatient ultrasound-guided test injection and specialist assessment of the response.
Is lumbar osteoarthritis on an MRI scan enough?
No. The pain must be consistent with a facet joint origin, and the response to the block must support the indication.
Will I need to stay overnight?
Usually not: this is a day surgery procedure, with observation and same-day discharge when clinically appropriate.
Can it also treat sciatica?
Facet denervation targets lumbar joint pain. Sciatica due to a nerve root problem has a different target and requires a specific pathway.
The PONOS specialist pathway
The decision starts with the cause of pain and the response to the block. Assessment, treatment and follow-up form a single personalised pathway.
Book an assessmentLumbar facet joint painSacroiliac radiofrequency denervationSelected reference
Cohen SP, Bhaskar A, Bhatia A, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Regional Anesthesia and Pain Medicine. 2020;45:424–467. PubMed · PMID 32245841.
Clinical content: Dr Evangelos Panagiotakos MD · Anaesthesiologist and Interventional Pain Specialist.