Medial branch block and facet RFA, by a consultant pain specialist.

Prices vary by unit, by which consultant does the case, by whether one or both sides are treated, and by the number of levels. Cervical RFA is typically a little more because of the extra imaging time.

1. 01

   Before

   You send us the MRI and pain history

   A short, confidential form. Where the pain sits (axial low back or neck, no true radiculopathy), duration, physiotherapy done, and the MRI report if you have one.

2. 02

   Before

   We come back with a recommendation

   Within one working day: whether the facet joints are a plausible pain source, whether MRI needs updating, and which pain consultant fits your case. Indicative price.

3. 03

   Before

   First diagnostic medial branch block

   Fluoroscopy or ultrasound-guided small-volume local anaesthetic to the medial branches supplying the suspected facet levels. A pain diary is kept for 24 hours.

4. 04

   On the day

   Second confirmatory block, on a separate day

   Only performed if the first block gave >80% pain relief. A second positive block confirms a facet-mediated pattern and justifies moving to RFA.

5. 05

   On the day

   Radiofrequency ablation of the medial branch

   Percutaneous 22G RFA needle, sensory and motor stimulation to confirm placement, then a lesion at 80 degrees Celsius for 90 seconds per level, with local anaesthetic and a small dose of steroid.

6. 06

   On the day

   Home the same day

   A short recovery, written aftercare, and home within a couple of hours. Driving next day if comfortable. Post-procedure ache for 3-7 days is common.

7. 07

   After

   Review at 6-8 weeks

   Peak benefit is at 6-8 weeks. We review, restart or step up physiotherapy, and plan repeat RFA when benefit fades (typically 6-18 months).

• Axial low back pain, worse with extension

  Deep, aching pain across the low back that flares when standing tall, arching backwards or standing for long periods.

• Cervical facet pain and cervicogenic headache

  Neck pain radiating to the occiput or between the shoulder blades, worse with rotation and extension. C2-C3 is a common source of cervicogenic headache.

• Post-fusion adjacent-segment facet pain

  A common pattern after lumbar fusion, where the joints just above the fused level take extra load and become symptomatic.

• Osteoarthritic Z-joint changes on MRI

  Hypertrophy, effusion or facet oedema on MRI in a distribution that matches the pain map - a supportive, not diagnostic, finding.

• Failed physiotherapy trial

  A minimum 6-12 week structured physiotherapy programme with limited benefit, before injections are considered.

• Not the right patient: true radiculopathy

  Leg-dominant pain, dermatomal numbness or a positive nerve-root tension sign points to disc or foraminal disease, not facets - MRI-guided epidural is the correct pathway.

• Not the right patient: red flag features

  Night pain, unexplained weight loss, fever, new bladder or bowel symptoms, or progressive neurological deficit need urgent NHS pathways, not private injections.

• Red flag: cauda equina symptoms

  Saddle numbness, urinary retention or bilateral leg weakness - go straight to A&E for emergency imaging, not a private booking.

• Bleeding and infection are uncommon

  Rates for both are below 1% for medial branch blocks and RFA. Anticoagulants and antiplatelets are reviewed with the team beforehand.

• No permanent nerve damage from medial branch RFA

  The medial branch is a purely sensory nerve supplying the facet joint and a small strip of paraspinal muscle. RFA does not cause weakness or numbness in the arms or legs.

• Post-procedure ache for 3-7 days

  A dull ache at the puncture sites and short-lived neuritic burning are common as the treated nerves settle. Simple analgesia and gentle movement help.

• Vasovagal response and steroid flare

  A minority feel lightheaded during the procedure, and a small number get a 24-48 hour flare from the local steroid. Both settle without treatment.

• Peak benefit at 6-8 weeks

  RFA does not switch pain off immediately - the treated nerve takes weeks to degenerate. Judge the response at 6-8 weeks, not the day after.

• Duration of benefit: 6-18 months

  Nerves regenerate. Most patients get 6-18 months of meaningful pain relief before symptoms return. Repeat RFA is straightforward when they do.

• Physiotherapy in the RFA window

  Use the pain-free window to build core strength, hip mobility and postural endurance. RFA works best as part of a rehabilitation plan, not on its own.

• Cervical RFA - vertebral artery caution

  Cervical procedures use meticulous fluoroscopy and repeated aspiration to avoid the vertebral artery. Only offered in units with a high cervical caseload.

• Red flags after discharge

  New leg or arm weakness, saddle numbness, bladder or bowel symptoms, spreading redness at the puncture site or fever - call the unit or go to A&E the same day.