Radiofrequency denervation (facet denervation)

Radiofrequency denervation is a procedure to treat back pain that originates in your facet joints.

What is radiofrequency denervation or facet denervation?

Radiofrequency denervation, also known as facet denervation, is a specialised form of treatment to cause heat damage to the two nerves that supply the facet joints, small pairs of joints which link your vertebrae together.

These nerves transmit pain sensations from the joints but have very little other function. By damaging them, the nerves stop sending pain signals to your brain.

Radiofrequency denervation is also known as facet rhizolysis, radiofrequency ablation or radiofrequency neurotomy.

Procedure type

Initial consultation price

Treatment price*

Monthly cost**

Member discount

Facet (radiofrequency) denervation

£210

From £2,750

From £66.48

10%

Facet (radiofrequency) denervation

Initial consultation price

£210

Treatment price*

From £2,750

Monthly cost**

From £66.48

Member discount

10%

I have a question about the facet denervation procedure

Why would I have a facet denervation procedure?

Your GP or Consultant may suggest facet denervation if your back pain starts in your facet joints. They’ll only suggest the radiofrequency denervation procedure if other treatments, such as physiotherapy, haven’t helped.

What does the facet denervation procedure involve?

Your Consultant will help you into position, so that you’re lying on your front. They’ll inject a local anaesthetic which will numb the area. Once the area is numb, your Consultant will pass a fine hollow needle towards the nerves, with the help of a Computerised Tomography (CT) scan.

When the needle is in the right place, they’ll pass a probe (thin wire) through the needle. The position of this probe is very important, so they’ll check using two tests:

Sensation – you may feel tightness, pressure or tingling in your back
Motor (movement) – You may feel some throbbing in your back. If you feel any throbbing in your leg, then your Consultant will reposition the probe

When the probe is correctly positioned, your Consultant will give you an intravenous sedative to relieve any discomfort during the procedure. The tip of the probe is heated to 80 degree centigrade, which is enough to cause a heat lesion to the nerve.

What are the possible risks and side effects of the facet denervation procedure?

As with all procedures, facet denervation carries some risks and side effects. We take every precaution to reduce the risks as far as possible but, in some cases, the following may occur:

Failure of the procedure to help
Worsening of pain (temporary or permanent)
Bleeding or bruising in the injected area
Infection in the injected area
Numbness of the injected area
Facial flushing for a few days
Leg numbness and weakness are very rare side effects

Is there any preparation for the facet denervation procedure?

Please let the Diagnostic Imaging department know if you’re diabetic, have a cough or cold or any kind of infection.

Important information

If you’re pregnant

Female patients who are, or might be, pregnant must inform the department in advance.

If you take Warfarin or any other blood-thinning medication

It’s essential that we know in advance if you’re taking any blood thinning medication as this may need to be stopped prior to the procedure. Failure to inform the department prior to your procedure date could result in your treatment being cancelled on the day.

Please call 01580 857 492 and ask to speak to the Imaging secretaries.

What will happen after I book my facet denervation procedure?

You’ll be given a date to attend the ward for pre-assessment. Once you’ve passed your pre-assessment, one of our nursing staff will escort you to our Diagnostic Imaging department for your procedure.

Here you’ll be introduced to the team looking after you in Diagnostic Imaging. This will include the Consultant Radiologist, Radiographers and Radiology Assistant.

Does the facet denervation procedure work and are there any alternatives?

It’s very likely that you will have already tried other treatments, such as painkillers and physiotherapy before being referred for radiofrequency denervation treatment but your Consultant can discuss alternatives with you.

If you’ve already responded well to diagnostic injections, the facet denervation procedure has a good chance of long-term relief from back pain.

It might take up to three weeks for you to feel any benefit, but about half of cases can expect relief from symptoms for between three months and one year.

It’s important to know that the nerve can regrow so your pain may come back. However, if you responded well to the first injection, you’re likely to benefit from a repeat injection.

How should I prepare for the facet denervation procedure?

You mustn’t eat or drink during the four hours prior to your appointment
Take your tablets (except blood thinning medication) as normal and bring a list of your medication with you
Please bring a dressing gown and sensible footwear

What happens before the facet denervation procedure?

Prior to your procedure a nurse will take some details from you and check you are fit for your procedure. You’ll be asked to sign a consent form and will have an opportunity to ask the Consultant Radiologist any questions.

What happens after the facet denervation procedure?

You should expect to remain on the recovery ward for 2-4 hours after. The nurse looking after you will ensure you are fit enough to go home prior to discharging you.

You must NOT drive home or travel home by public transport. Please arrange for someone to collect you from the hospital. You may however travel home by taxi.

Once you’re at home, it’s important that you rest for a couple of hours before you start to resume your normal activities. Don’t do any excessive exercise or heavy work for the first few days.

Continue to take your pain tablets until you notice any improvements in your symptoms. You can remove the dressing over the treatment site the following morning after the procedure.

If you have any concerns, please contact the Imaging Department on 01580 857 492 and speak with one of our Radiographers. If you need to contact someone out of hours, call NHS 111 and tell them you’ve had this procedure.

How much does radiofrequency denervation cost?

To find out more, complete our online quotation form or call our Private Patient Team on 01580 363158.

Spread the cost of your private facet denervation treatment

Take advantage of payment plans through our trusted partner, Chrysalis, and spread the cost of your treatment. Fit your repayments into your monthly budget rather than having to find the full cost at the time of your treatment.

Radiofrequency denervation for back pain at Benenden Hospital

Dr Mo Faris, Consultant Interventional Radiologist, talks about our self-pay facet denervation procedure for lower back pain.

Video transcript

Generally speaking, back pain affects a huge portion of people at some point in their lives. The persistence of back pain can be life-limiting, reducing enjoyment and significantly impacting mental health. While no single solution can address all aspects of back pain, reducing the pain can help address related issues such as weight gain due to the inability to exercise. This can lead to improvements in self-belief, self-worth, confidence, and mental health.

The normal pathway for being referred for lower back pain involves seeing spinal surgeons. They assess the likelihood of the cause of the pain and conduct investigations, commonly an X-ray or MRI scan. If deemed appropriate, they may perform an intervention such as an injection. If you have a positive response to the injection, you may then be referred for denervation.

Facet denervation uses thermal heat to ablate the nerve endings that supply the facet joints in the back. Without nerve endings that sense pain, you don't feel the pain. Lower back pain can have multiple causes, and it can be difficult to pinpoint the exact cause despite various tests, including MRI. To identify the cause, an injection is often performed initially to see if there is relief and to quantify the improvement. If there is significant improvement, it indicates that a more prolonged response from facet denervation may be beneficial.

At Benenden, we have a great team of specialists, including fantastic spinal surgeons who will be your initial point of contact. They will likely refer you for an MRI, and you may then be seen by a physiotherapist or myself for either an injection or the denervation procedure.

On the day of the procedure, which is a day case lasting approximately 4 to 6 hours, you will have a cannula placed in your hand for sedation. You will be assessed by the sedation provider and myself, and we will go through the consent process. You will then be taken to the CT scanner, which is an open donut-shaped scanner, to guide the procedure. You will lie on your front, and markers will be placed on your back. The CT scan will help us position the needles accurately. Local anaesthetic will be applied to the skin, and the needles will be placed and confirmed by the scan. We will perform sensory and motor tests to ensure we target the correct nerves. Once confirmed, sedation will be administered, and the ablation will take about 3 minutes.

After the procedure, you will be taken to recovery and then back to the ward. You will stay for about two hours, depending on your response, and then you can go home. It is important not to drive yourself to the procedure and to have someone to take you home. Most people experience mild bruising or soreness afterward, and occasionally temporary numbness in the lower back and legs, which resolves within a few days.

The nerves may be inflamed after the procedure, taking up to two weeks to settle down. You may experience discomfort and soreness, and we advise taking your usual pain medication. The improvement from the procedure can last between six months to 18 months, and in some cases, even longer. It is important to use this pain-free period to stabilise and strengthen your core to support your back and reduce the risk of ongoing back problems.

Facet denervation is not a one-stop solution but can be part of chronic management for back pain. The frequency of the procedure depends on how quickly your nerve endings grow back. Some patients have yearly or bi-yearly denervation and maintain normal function in between.