Thoracic Radiofrequency (RF) Neurotomy


The zygapophysial joints (z-joints) are small joints between the bones that make up the spine. These z- joints may become a cause of chronic back pain. Thoracic radiofrequency neurotomy can be performed to provide longer lasting pain relief if a diagnosis of z-joint pain has been made with two separate medial branch blocks. The procedure uses RF energy that results in heat generation causing a disruption of proteins in the nerves that supply the z-joints, and hopefully prolonged pain relief.


The injection requires use of x-ray and/or ultrasound (US) to precisely place the needle. Therefore, if you are pregnant, please inform your physician prior to the procedure. The amount of x-ray exposure is within recommended safe limits for adults, but can be hazardous to the developing fetus.

If you are on blood thinners or anticoagulants, please notify your physician. Special precautions or medication adjustments may be deemed necessary. However, do not stop your medication without consulting with your physician.

You will require a driver after the procedure as it may be unsafe to operate a vehicle.

Notify your physician of any allergies you may have.

Before the procedure:

Take your medications as prescribed. You may be given a sedative medication prior to the procedure.

During the procedure:

You will be placed onto a special table for the procedure. After cleansing the skin, drapes will be applied to ensure sterility. The x-ray machine will be maneuvered to a satisfactory position. A needle will be placed precisely to the target nerve branch and numbing medication (local anesthetic) injected. After removing the initial needle, a RF needle will be directed to the same location. This should not be uncomfortable as the track of the RF needle was previously numbed. After the RF needle are placed, a small amount of electrical current is passed through the tip of the needle to assure a safe distance from other nerves. The RF energy then generates heat at the end of the needle electrode that will create a lesion of the targeted nerve. You may feel some initial discomfort when the heating begins, though it should quickly subside. After the first lesion is completed, the RF needles will be adjusted and additional lesions preformed. This allows for a larger lesion thereby treating more of the targeted nerve resulting in greater benefit than single lesions.

After the procedure:

Your skin will be cleansed and a bandage applied as necessary. You will be taken to an observation area and monitored for any adverse reactions, which are very rare. Keep in mind, the greatest benefit following radiofrequency neurotomy will often be experienced in 4-6 weeks.

Side effects or complications:

Side effects are generally minimal and can include increased discomfort, local bruising, headache, nausea, fainting or dizziness. These symptoms are usually short-lived and will resolve themselves. More severe complications are rare such as infection, allergic reaction, pneumothorax(collapsed lung) or nerve injury.

If you have any questions or concerns, please contact us at (610)954-9400.