Concierge pain medicine · UK
RF neurotomy - only after two positive blocks.
Fluoroscopy-guided radiofrequency lesioning of the medial branch nerves for confirmed lumbar or cervical facet-joint pain. Consultant pain-medicine led, two-block diagnostic pathway enforced, physiotherapy built into the plan.
Why patients choose us
- 01
Dual diagnostic blocks before you ever get lesioned
Two separate medial-branch blocks on different days must both give real relief before we agree to neurotomy. A single positive block has a 30–40 percent false-positive rate.
- 02
A consultant pain specialist in a fluoroscopy suite
A named pain-medicine consultant working under live X-ray or CT - not an ultrasound-only clinic room and never a physio doing injections.
- 03
Independent, and free
We are paid by no clinic, so the recommendation - and whether physiotherapy or a facet steroid should come first - is impartial and costs you nothing.
Indicative pricing
What private RF neurotomy costs in the UK.
Indicative ranges across our partner pain-medicine units. Send your MRI report and pain history, and we quote firm figures across two or three options, with cover checked.
In short
Lumbar RF neurotomy in our network: £1,800–£3,500 per side, home the same day.
| Procedure | Indicative range | Typical duration | Stay |
|---|---|---|---|
| Pain-medicine consultation + MRI review | £300–£500 | 30–45 min | Same visit |
| Diagnostic medial branch block (per side, per level set) | £800–£1,400 | 20–30 min | Walk-in walk-out |
| RF neurotomy - lumbar, one side, up to 3 levels | £1,800–£3,500 | 45–60 min | Day-case |
| RF neurotomy - cervical, one side, up to 3 levels | £2,200–£4,000 | 60–75 min | Day-case |
| RF neurotomy - bilateral, same visit | £3,000–£5,500 | 75–105 min | Day-case |
| Cooled RF (Coolief) - sacroiliac or hip | £2,500–£4,500 | 60–90 min | Day-case |
| Repeat neurotomy at recurrence | £1,800–£3,500 | 45–60 min | Day-case |
Prices vary by hospital, region, whether the target is lumbar or cervical, and how many levels are treated. Cooled RF platforms (Coolief) for the sacroiliac joint and knee are always the top of the range. The two diagnostic blocks are billed separately - factor them in when comparing quotes.
The problem
The right diagnosis, the right target, and a rehab plan for the pain-free window.
Facet neurotomy is the corner of interventional pain most often done under-selected - one block instead of two, ultrasound instead of fluoroscopy, no rehab afterwards. We fix all three before the electrode goes in.
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Two blocks, not one
A single positive block has a 30–40 percent false-positive rate. Two concordant blocks on separate days is the evidence-based threshold - anything less is guesswork.
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Fluoroscopy or CT, never ultrasound alone
The medial branch is a millimetre-scale target on a bony landmark. Live X-ray is the only reliable way to place the electrode accurately.
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Neurotomy is a window for rehab
Six to 24 months of relief is a chance to rebuild core strength and movement conditioning. A neurotomy without physiotherapy is a wasted opportunity.
The journey
From enquiry to durable relief - what happens, in order.
One team from first message through the two diagnostic blocks, neurotomy and physiotherapy.
Phase 1 · Before neurotomy
Assessment and two diagnostic blocks
Phase 2 · On the day
Fluoroscopy and lesioning
Phase 3 · After
Physiotherapy and relief
- 01
Before
You tell us the story of your pain
A short, confidential form. Where it hurts, what it does with movement, past MRIs, what physio and drugs have been tried, and whether you have had blocks before.
- 02
Before
We come back with a recommendation
Within one working day: whether facet-mediated pain is likely, whether MRI is needed, an indicative price per level, and how the two-block diagnostic pathway will be sequenced.
- 03
Before
First diagnostic medial branch block
A tiny volume of local anaesthetic placed on the medial branch nerves under fluoroscopy. Immediate response and a two-hour pain diary tell us whether the joints are the culprit.
- 04
Before
Second (confirmatory) block on a separate day
Repeated 2–4 weeks later. Only patients with two clearly concordant positive blocks proceed to neurotomy - this is the evidence-based threshold.
- 05
On the day
Radiofrequency neurotomy under fluoroscopy
Local anaesthetic and light sedation. RF electrodes are placed on the medial branches and heated to 80 °C for 90 seconds per nerve. Typically 45–75 minutes for 2–4 nerves per side.
- 06
On the day
Discharge same day
One to two hours in recovery. Home the same day with a written aftercare sheet. Post-procedure soreness for 3–10 days is normal - the pain often gets worse before it gets better.
- 07
After
Physiotherapy and durable relief
Pain relief begins at 2–6 weeks as the nerve inflammation settles. A structured physiotherapy programme starts at 4 weeks to build core strength while you are pain-free. Relief typically lasts 6–24 months; repeat lesioning is possible when the nerve regrows.
Typical end-to-end: 6–10 weeks from enquiry to neurotomy (two blocks first). Relief lasts 6–24 months, repeatable at recurrence.
When it helps
When RF neurotomy is the right step.
The situations we see most, plus the one red flag that means emergency spinal review rather than a pain-clinic booking.
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Axial lumbar pain worse on extension
Low-back pain that worsens standing, walking downhill or leaning back, eased by sitting forward - the classic facet pattern.
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Cervical facet pain after whiplash
Neck and occipital pain following a rear-end collision, worse on rotation and extension - the C2/3–C6/7 facets are the commonest driver.
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Thoracic facet pain
Interscapular ache localised to one or two segments, worse on rotation. Less common but a well-recognised indication.
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Cervicogenic headache
Occipital-to-forehead headache driven by C2/3 or C3 third-occipital-nerve joint dysfunction, confirmed by third-occipital-nerve block.
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Post-fusion adjacent-segment pain
Pain from a facet above or below a spinal fusion - RF neurotomy is one of the few effective options here.
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Sacroiliac joint pain (cooled RF)
Lateral branches of the S1–S3 posterior rami lesioned with cooled RF for confirmed SIJ pain that has failed injections and physiotherapy.
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Genicular nerves for chronic knee pain
Superior/inferior lateral and inferior medial genicular nerves lesioned for chronic osteoarthritic knee pain not fit for or awaiting arthroplasty.
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Red flag: new leg weakness, saddle numbness, bladder/bowel change
These are cauda equina or myelopathy symptoms - same-day A&E or emergency spinal team, not a pain-clinic booking.
Procedure options
Target and technique both depend on the joint.
What each option involves - spinal level (cervical, thoracic, lumbar) and technique (conventional thermal RF, cooled RF, pulsed RF or CT-guided).
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Lumbar medial branch neurotomy
The workhorse. Two nerves per facet joint (the medial branch of the level and the level above) lesioned under fluoroscopy. Typically L3, L4 and L5 dorsal rami plus the L5 dorsal ramus itself.
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Cervical medial branch neurotomy
Third-occipital nerve for C2/3 and medial branches of C3–C7 for the mid- and low-cervical joints. Requires precise multi-lesion technique for durable relief.
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Thoracic medial branch neurotomy
Less commonly done but effective for confirmed thoracic facet pain, particularly after rib fracture or postural strain.
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Sacroiliac joint (cooled RF, Coolief)
Lateral branches of the S1–S3 posterior rami lesioned with cooled radiofrequency, which creates a larger burn zone suited to the variable SIJ anatomy.
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Genicular RF for knee osteoarthritis
Three genicular nerves lesioned around the knee for chronic OA pain - a well-evidenced option for patients unsuitable for or delaying knee replacement.
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Pulsed radiofrequency (PRF) - nerve-sparing
A lower-temperature technique that modulates rather than ablates. Used for dorsal root ganglia and neuropathic pain where a full thermal lesion is contraindicated.
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CT-guided neurotomy for difficult anatomy
For post-surgical spines, deformity or aberrant anatomy, CT guidance allows sub-millimetre placement that fluoroscopy sometimes cannot deliver.
Our vetted UK network
A small panel of pain-medicine consultants, we picked them.
Consultant pain-medicine physicians and spinal interventionalists across London and the major UK cities. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every pain-medicine consultant in our network.
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Consultant pain-medicine physicians (FFPMRCA or FRCA with pain fellowship), not physios or trainees, on the injection list
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Fluoroscopy or CT guidance for every diagnostic block and every neurotomy - landmarks or ultrasound alone are not enough for facets
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Two-block diagnostic protocol enforced - single-block pathways are rejected
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Access to spinal MRI, structured physiotherapy and psychology to place neurotomy in a full biopsychosocial plan
Safety and recovery
What to expect afterwards - honestly.
RF neurotomy is a mature, well-studied intervention. The things worth planning are the short flare-up, the rehab window and the fact that the nerve will eventually regrow.
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Local anaesthetic with light sedation
Almost always done under local with a small dose of midazolam and fentanyl. General anaesthetic is avoided because your feedback during test stimulation confirms correct nerve placement.
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Post-procedure soreness for 3–10 days
A dull ache, sometimes worse than baseline, for 3–10 days as the nerve inflammation settles. Paracetamol, ibuprofen and a short course of ice usually handle it. Real relief begins at 2–6 weeks.
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Neuritis and paraesthesia
A burning or tingling sensation in the treated area affects around 5 percent of patients and settles within 6–8 weeks. A short course of gabapentin or pregabalin helps if it is bothersome.
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Numbness over the treated area
A small patch of numb skin behind the joint is expected - the medial branch also carries a sensory twig. It is not a complication, and most patients do not notice it.
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Bleeding and infection are rare
Both under 1 in 1,000 with modern technique. Anticoagulants and antiplatelets are reviewed on a case-by-case basis using UK pain-society guidance - most can continue with careful planning.
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Motor-nerve injury is very rare
The medial branch is a sensory nerve to the facet joint. Correct fluoroscopic placement and sensory/motor test stimulation before lesioning make motor injury exceptionally uncommon.
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Not for radicular (nerve-root) pain
RF neurotomy treats facet-joint pain only. It does not treat sciatica, radiculopathy or nerve-root compression - those are addressed by epidural steroid or surgery.
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Durable, not permanent
The medial branches regrow over 6–24 months. When pain returns, a repeat neurotomy typically works as well as the first - this is a normal part of the treatment, not a failure.
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Red flags after treatment
New leg or arm weakness, loss of bladder or bowel control, saddle numbness, spreading redness with fever or severe unexplained pain need the same-day team or A&E - not a routine call.
Reading your procedure note
Your neurotomy report in four parts. Read the last one first.
Whichever technique was used - conventional thermal, cooled or pulsed - the note the pain specialist sends you keeps to the same shape.
A quiet reminder
Interventional pain language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the neurotomy note and the physiotherapy plan before your review, just ask.
- 01 Header
Diagnosis, target and side
Why the neurotomy was done, which spinal level and side, and whether it followed two positive medial branch blocks - the evidence-based threshold.
- 02 Technique
Guidance, electrode and lesion parameters
Fluoroscopy or CT, needle gauge, sensory and motor test stimulation results, and the lesion parameters (typically 80 °C for 90 seconds, often with two burns per nerve at slightly different angles).
- 03 Findings
Nerves treated and immediate response
The medial branch nerves that were lesioned (for example L3 and L4 medial branches plus the L5 dorsal ramus for L4/5 and L5/S1 joints), and your response to test stimulation and immediate local anaesthetic.
- 04 Impression
Physiotherapy plan and expected relief
Read this first: when to start physiotherapy, when pain relief should kick in, how long to expect it to last, and when to consider a repeat if pain returns.
Recognised by major UK insurers
RF neurotomy after two positive medial branch blocks is covered by most UK insurers. Some policies fund repeat neurotomies only after a defined interval - we check the small print before booking.
Frequently asked
Everything we get asked about facet-joint RF neurotomy.
Quick answers on diagnostic blocks, duration of relief, cost, safety and the essential role of physiotherapy.
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What is radiofrequency neurotomy of the facet joints?
It is a fluoroscopy-guided procedure that uses a heated electrode to interrupt the small medial branch nerves that carry pain signals from a facet joint. The joint itself is left alone; only the sensory nerves supplying its capsule are lesioned. Done properly after two positive diagnostic blocks, it gives 6–24 months of meaningful pain relief in around 60–80 percent of well-selected patients.
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Why do I need two medial branch blocks before neurotomy?
A single diagnostic block has a false-positive rate of 30–40 percent - pain relief on one day can come from placebo, muscle relief or systemic effect. UK and international pain-medicine guidance therefore requires two concordant positive blocks on separate days before proceeding. It sounds slow, but it is what separates neurotomy that works from neurotomy that disappoints.
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How long does the neurotomy take and is it painful?
The procedure itself takes 45–75 minutes for 2–4 nerves per side. You are awake with light sedation, lying face-down on a fluoroscopy table. The local anaesthetic stings briefly; the lesioning itself is felt as a dull warmth. Post-procedure soreness lasting 3–10 days is normal - the pain relief you are hoping for begins at 2–6 weeks as nerve inflammation settles.
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How long will the relief last?
The medial branch nerves regrow slowly, so relief typically lasts 6–24 months, with an average of about 12 months. When the pain returns, a repeat neurotomy usually works as well as the first - this is expected, not a failure. Most patients settle into a rhythm of one procedure every 12–18 months.
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Which joints can be treated with RF neurotomy?
Lumbar and cervical facets are the commonest targets. Thoracic facets, the sacroiliac joint (cooled RF of the lateral branches), and the genicular nerves around the knee are also well-evidenced indications. Cervicogenic headache from the C2/3 joint responds to third-occipital-nerve neurotomy.
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What are the risks?
Neuritis or a burning sensation in 5 percent, settling in 6–8 weeks. Bleeding and infection under 1 in 1,000. A small permanent patch of numb skin behind the joint is expected. Motor-nerve injury is exceptionally rare with proper fluoroscopic technique and pre-lesion motor test stimulation. RF neurotomy does not treat sciatica or radicular pain.
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How much does private RF neurotomy cost in the UK?
Roughly £800–£1,400 per diagnostic medial branch block (usually two are needed), then £1,800–£3,500 for lumbar neurotomy of up to 3 levels on one side, £2,200–£4,000 for cervical. Bilateral treatment at the same visit is £3,000–£5,500. Cooled RF (SIJ, knee) is £2,500–£4,500. We confirm firm figures within one working day.
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Do I still need physiotherapy afterwards?
Yes - this is the piece most clinics under-sell. Neurotomy gives you a 6–24 month window without pain. The evidence is clear that structured physiotherapy during that window - core strengthening, load management, movement retraining - extends the benefit and reduces recurrence. Neurotomy without a rehab plan is a missed opportunity.
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