Radiofrequency Ablation (RFA) in Miami
Radiofrequency ablation (RFA) — also called radiofrequency neurotomy — is a minimally invasive procedure that uses heat energy to disrupt the small nerves responsible for transmitting pain from arthritic or injured facet joints. For patients who have confirmed facet-mediated spine pain with positive medial branch blocks, RFA offers one of the most durable non-surgical pain relief options available — with relief typically lasting 6 to 12 months or longer.
At our Miami clinic, Dr. William Bonner performs RFA under fluoroscopic (X-ray) guidance to ensure precise needle placement and to maximize both safety and effectiveness.
How Does Radiofrequency Ablation Work?
RFA works by delivering a controlled radiofrequency electrical current through a specialized needle electrode placed along the medial branch nerves — the small nerves that carry pain signals from the facet joints to the brain. The current generates heat at the tip of the electrode, which disrupts nerve conduction and interrupts the pain signal.
The result is a significant reduction in facet-mediated pain that can last from several months to well over a year. Over time, nerves can regenerate — at which point the procedure can be repeated if symptoms return.
Important: RFA does not damage the facet joint itself, only the small pain-transmitting nerves are targeted.
Who Is a Candidate for Radiofrequency Ablation?
RFA is not a first-line treatment — it follows a specific diagnostic pathway. You may be a candidate for RFA if you:
- Have confirmed facet-mediated neck or back pain with two positive medial branch blocks
- Have pain that has not responded adequately to physical therapy and medications
- Have had meaningful but temporary relief from prior facet injections or medial branch blocks
- Prefer a longer-lasting non-surgical option before considering spine surgery
- Are medically appropriate for the procedure (discussed at consultation)
Patients who have not completed the two-block diagnostic protocol are not yet candidates for RFA. If you have not had medial branch blocks, the first step is a diagnostic medial branch block evaluation.
Conditions Treated With RFA
- Cervical facet arthropathy (neck facet pain)
- Lumbar facet arthropathy (low back facet pain)
- Thoracic facet pain
- Chronic axial neck or back pain confirmed as facet-mediated
- Post-surgical spine pain with a confirmed facet component
- Chronic pain at multiple spinal levels
RFA is not typically indicated for disc-related pain or nerve root compression (radiculopathy/sciatica) — those conditions have different treatment pathways.
The RFA Treatment Pathway
Step 1: Diagnostic Medial Branch Blocks
Two separate positive medial branch blocks confirming facet-mediated pain are required before RFA is performed. These are typically done on different visits, with careful pain tracking after each procedure.
Step 2: Radiofrequency Ablation
Once candidacy is confirmed, RFA is performed under fluoroscopic guidance. Multiple levels are often treated in the same session, depending on your diagnosis.
Step 3: Recovery and Rehabilitation
Most patients resume normal activities within a few days to a week. Physical therapy may be recommended alongside RFA to address contributing movement dysfunction and maximize long-term outcomes.
Step 4: Long-Term Management
Relief from RFA typically lasts 6–12 months or longer. As nerves regenerate over time, symptoms may gradually return — at which point the procedure can be repeated if the patient again responds positively to confirmatory diagnostic blocks.
Why Is Fluoroscopic Guidance Essential for RFA?
Precise electrode placement is fundamental to both the safety and effectiveness of radiofrequency ablation. The medial branch nerves are located at specific anatomical landmarks that cannot be reliably targeted without real-time imaging. Without fluoroscopic guidance:
- The electrode may not be positioned at the correct anatomical location, reducing effectiveness
- There is an increased risk of unintended nerve or tissue contact
- Sensory and motor testing — critical safety steps — cannot be performed accurately
Dr. Bonner performs all RFA procedures under fluoroscopic guidance with contrast confirmation and pre-ablation nerve testing as the standard of care.
What to Expect During Radiofrequency Ablation
The procedure is performed in-office and typically takes 30 to 60 minutes depending on how many levels are treated:
- You are positioned comfortably, typically face down on a procedure table
- The skin over the treatment area is cleaned and numbed with local anesthetic
- Using fluoroscopy, Dr. Bonner precisely positions the RFA electrode(s) along the medial branch nerves at each target level
- Contrast dye is used to confirm accurate needle position before any energy is delivered
- Sensory and motor testing are performed to ensure correct placement and confirm the electrode is not near a motor nerve
- Radiofrequency energy is applied for 90 seconds per target, generating controlled heat at the nerve
- You are monitored briefly and then go home the same day
Most patients experience mild soreness in the treated area for several days following the procedure. Full relief may develop gradually over 2–6 weeks as the nerve disruption takes effect.
RFA vs. Other Facet Pain Treatments
| Treatment | Duration of Relief | Best For |
| Facet Joint Injection | Weeks to months | Diagnostic + acute therapeutic relief |
| Medial Branch Block | Hours to days (diagnostic phase) | Diagnosis, pre-RFA confirmation |
| Radiofrequency Ablation (RFA) | 6–12+ months | Confirmed facet pain, longer-lasting relief |
| Physical Therapy | Long-term with compliance | Supportive; addresses movement dysfunction |
| Repeat RFA | 6–12+ months per treatment | When nerves regenerate and symptoms return |
Frequently Asked Questions
How long does it take to feel the results of RFA?
Relief develops pretty soon after RFA. Many patients notice improvement within 1–3 weeks, with maximum benefit typically felt by 4–6 weeks after the procedure.
Is radiofrequency ablation painful?
The procedure is performed under local anesthesia and is generally well-tolerated. Patients typically experience mild discomfort from the numbing injections. A brief burning or aching sensation may occur during energy delivery, but this resolves quickly. Post-procedure soreness for several days is common and expected.
How long does relief from RFA last?
Most patients experience meaningful pain relief for 6 to 12 months, and some maintain relief for 18 months or longer. Results vary based on the number of levels treated, the extent of degeneration, and individual factors.
Can RFA be repeated?
Yes. As the medial branch nerves gradually regenerate over time, symptoms may return. If this occurs, the diagnostic protocol (medial branch blocks) is typically repeated to confirm ongoing facet-mediated pain, and RFA can be performed again.
Does RFA damage the facet joint or surrounding structures?
No. RFA specifically targets the small medial branch nerves that supply the facet joint. It does not damage the joint capsule, cartilage, surrounding muscles, or other spinal structures.
Will I need physical therapy after RFA?
Physical therapy is often recommended alongside RFA. The pain relief provided by RFA creates a window of opportunity to engage more effectively in rehabilitation — strengthening the muscles that support the spine and addressing contributing movement problems that may have developed due to chronic pain.
Is RFA covered by insurance?
Radiofrequency ablation is covered by many insurance plans when appropriate diagnostic criteria are met — including two positive medial branch blocks. Dr. Bonner’s team will work with you to verify coverage and navigate prior authorization requirements.
Schedule a Consultation
If you are experiencing neck pain or low back pain, or other spine-related symptoms and want to determine whether an radiofrequency ablation (RFA) is appropriate for you, we are here to help.
Contact our Miami clinic to schedule an appointment with Dr. Bonner, or book online through ZocDoc for available appointment times (if you do not see availability, please reach out to us directly at 786-522-4959).