Cervical Radiofrequency Ablation Explained

Cervical radiofrequency ablations treat chronic neck pain and headaches due to changes in the cervical spine, according to 2021 research. The cervical spine is the topmost part of the spine and contains the first seven vertebrae. These vertebrae support your head and neck.

Changes to the typical makeup of the structures in and around the vertebrae can cause a specific headache type called a cervicogenic headache. An estimated 4.1 percent of the population experiences this headache type, with the average age of onset around 43.

Cervicogenic headaches can be difficult for a doctor to diagnose. According to 2018 research, major symptoms include:

• pain, usually on one side of the head
• poor range of motion in the neck
• head pain that worsens with neck movement
• head pain that worsens when a doctor presses the affected side of the neck
• pain that radiates down the neck, shoulder, or arm
• pain that doesn’t respond to traditional headache medications, like ergotamines, triptans, or indomethacin

A doctor can also perform a special nerve block type called a cervical block. If the headache improves with this block, then a cervicogenic headache is likely happening.

A cervical radiofrequency ablation procedure isn’t the first line of treatment for a cervicogenic headache. Instead, doctors often recommend taking nonsteroidal anti-inflammatory drugs (NSAIDs). If these are ineffective, a doctor may prescribe medications, such as tizanidine, baclofen, or tricyclic antidepressants.

Physical therapy or anesthetic nerve blocks may also help, according to the 2018 research mentioned earlier. If these treatments aren’t effective, a doctor may recommend radiofrequency ablation.

Cervical radiofrequency ablation involves using heat to burn the nerve tissue so the nerves cannot transmit pain signals to the brain. The basic steps of the procedure include:

1. A doctor will inject a local anesthetic to numb the skin.
2. A doctor will insert a thin needle near a facet joint, which is a bone that connects the vertebrae. They usually do this while being guided by a live X-ray, but some doctors may use computed tomography (CT) or ultrasound guidance.
3. A doctor will then stimulate the nerve by sending a small amount of electric current through the needle. This will likely cause your muscle to twitch and may cause some discomfort.
4. A doctor will deliver radiofrequency energy via the needle to keep nerve impulses from transmitting.
5. A doctor may repeat the procedure at another level or area of the cervical spine.

A cervical radiofrequency ablation is an outpatient medical procedure. You will go home the same day you have the procedure.

You should review your medical history and medications taken with your doctor before you undergo a cervical ablation. If you take blood-thinning medications, your doctor should discuss the prescribed blood thinners to see if you can stop taking them before the procedure.

You don’t typically need to do anything special to prepare for a cervical ablation. Your doctor should provide instructions for the day of your procedure and for care afterward.

Cervical radiofrequency ablation costs vary based on your location, the doctor performing the procedure, and how many levels the doctor is injecting. One pain clinic reported the cost at $3,195 for a one-level cervical radiofrequency ablation with $1,457 for an additional level.

Is nerve ablation covered by insurance?

Medicare covers cervical radiofrequency ablation, provided a person meets their criteria. If Medicare covers a procedure, other insurance companies typically will as well.

You should check with your insurance company first since they will often have their own requirements before they’ll cover your procedure.

Cervical radiofrequency ablation does have potential risks, but most are considered mild to moderate, according to 2021 research.

Since there are many blood vessels in the neck region, it’s possible a doctor could accidentally hit a blood vessel with a needle and cause bleeding. Image guidance helps reduce the risks of this effect.

Common potential side effects of cervical radiofrequency ablation include:

• dizziness
• discomfort or pain
• poor coordination
• skin numbness

These symptoms do not typically last more than a few days or weeks.

Some people shouldn’t undergo radiofrequency ablation due to increased risks. This includes those on anticoagulation therapy due to the potential for bleeding.

Those with implantable cardiac devices also shouldn’t undergo ablation without a doctor’s consultation, as the radiofrequency could elicit a shock or interfere with cardiac pacing.

Doctors consider some side effects possible with cervical radiofrequency ablation even if they haven’t been reported in larger studies. These possible effects include:

• epidural hematoma
• infection
• nerve damage
• spinal cord injury

A doctor should use imaging to minimize these risks. Without using imaging, some insurances companies may not reimburse for the procedure since its risks are higher.

Another rare but potential complication is dropped head syndrome. This condition causes severe muscle weakness that makes raising the head more difficult. Only two case reports have explained this potential effect.

Cervical radiofrequency ablation is not permanent. With time, the nerves will regenerate, and the pain can sometimes return. The timeline and likelihood that this will occur vary from person to person.

The 2021 research from earlier found that the average time of radiofrequency ablation effectiveness was 42 months. However, other reports have shorter times for pain recurrence, anywhere from 6 to 14 months.

Cervical radiofrequency ablation can cause initial nerve irritation for several days after your procedure. Sometimes, a doctor will prescribe steroids to help minimize this irritation.

You should expect your pain to begin improving within 3 to 6 weeks. If the pain doesn’t improve, the procedure may not be effective in relieving your neck pain.

Contact your doctor if you do experience weakness or numbness in your neck and shoulders that worsens or lasts longer than a few days.

Doctors may recommend multiple radiofrequency ablation visits to initially experience relief. Multiple visits are beneficial if you require radiofrequency ablation at more than two levels of the cervical spine.

Doctors will usually only perform the ablation on two areas of the spine at a time. Doing so helps ensure they don’t ablate too many nerves, which could affect your sensation and motor function.

If you’ve had cervical radiofrequency ablation and experienced pain relief, the chances are higher that a repeat procedure will help relieve your pain.

However, there is no research that specifies a maximum limit for repeating the procedure. Some studies have reported patients who have had at least seven radiofrequency ablation procedures.

The American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine do not recommend repeating the procedure more than twice a year.

What is the next step if radiofrequency ablation doesn’t work?

If a cervical radiofrequency ablation doesn’t work, a doctor may recommend the following treatments:

• medication
• physical therapy
• surgery

A doctor should carefully review each option’s risks and benefits with you.

Cervical radiofrequency ablation can help individuals with certain types of neck pain find at least temporary relief from their discomfort. Insurance will typically cover the procedure and may cover repeated procedures if you initially experienced pain relief.

Your doctor can help you determine if this procedure may be right for your neck or headache pain.