Individuals suffering from low back pain often struggle with daily activities. Standing for long periods or sitting continuously can lead to pain in the lumbar region. Specialists first perform a thorough examination for these complaints. Then, magnetic resonance imaging is used to identify the source of the pain.
Based on the identified problem areas, radiofrequency treatment or specialized injections may be applied. These treatments help alleviate low back pain and similar methods can be chosen for neck pain. This allows patients to eliminate their pain and enjoy a more comfortable life.
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
Facet Thermal Radiofrequency Treatment for Low Back Pain Not Radiating to the Legs
One method used in low back pain treatment is facet radiofrequency therapy. This treatment can be especially effective for chronic pain. The process involves a minimally invasive procedure performed through the skin.
During the procedure, a radiofrequency needle is positioned using imaging techniques such as fluoroscopy. To block pain signal transmission, targeted radio waves are sent via the radiofrequency device. As a result:
- Transmission of pain signals to the spinal cord is reduced.
- Pain management provides long‑term relief.
- Patients return to daily activities more quickly.
This treatment is an option for managing chronic low back and neck pain, which typically worsens with prolonged standing or sitting and improves with rest. It can provide relief for 6–12 months, but patients should avoid simultaneous pain‑inducing movements and work on weight reduction.
Dorsal Root Ganglion Pulsed Radiofrequency Treatment for Low Back Pain
Another method used in low back pain treatment is Dorsal Root Ganglion (DRG) Pulsed Radiofrequency therapy. This treatment is particularly effective for chronic pain and increases both efficacy and duration when treating disc herniations pressing on nerve roots. The process involves a minimally invasive procedure performed through the skin.
During the procedure, a radiofrequency needle is positioned using imaging techniques such as fluoroscopy. To block pain signal transmission, targeted radio waves are sent via the radiofrequency device. As a result:
- Transmission of pain signals to the spinal cord is reduced.
- Pain management provides long‑term relief.
- Patients return to daily activities more quickly.
This treatment is an option for managing chronic low back and neck pain. *We recommend filling out all fields so we can respond in the best possible way.
Indications for Dorsal Root Ganglion Pulsed Radiofrequency Therapy
In conditions like intervertebral disc herniation, pain can be continuous and severe. Traditional pain management may be insufficient for some patients, and surgery may not be appropriate. At this point, Dorsal Root Ganglion (DRG) Pulsed Radiofrequency therapy becomes an option. This method is recommended in:
- Patients for whom traditional methods like medication and physical therapy fail to provide adequate pain control.
- Cases where surgical intervention is deemed unsuitable or high‑risk.
- Chronic low back and neck pain radiating to one or both legs or arms, especially when nerve roots are involved.
This therapy modulates pain signals, reducing transmission in affected nerve roots. As a result, patients manage their pain better and continue daily activities.
Procedure Steps for Pulsed Radiofrequency Treatment of Low Back Pain
The physician first conducts a comprehensive evaluation to identify pain points, reviewing medical history and assessing symptoms. Diagnostic imaging (MRI or CT) locates herniated discs and affected nerve roots.
Pre‑Procedure Preparations:
- Day‑care admission the day before the procedure.
- Patient wears hospital gown; IV access established for fluids and medications.
- Patient positioned prone in the procedure room.
Vital signs (oxygen saturation, blood pressure, heart rate) are monitored throughout. Sedatives and local anesthesia are administered for comfort and to prevent pain.
Needle Placement:
- Using fluoroscopy or angiography (X‑ray guidance), the needle is precisely positioned at the target nerve root.
After placement, sensory and motor stimulation tests confirm proximity to the nerve root—sensory via tingling, motor via muscle twitches, with patient feedback.
Radiofrequency Application:
- Once correctly placed, pulsed radiofrequency energy is delivered.
The device generates energy transmitted to the nerve root, heating it up to 42 °C to interrupt pain signal transmission, leading to pain reduction and gradual relief.
Post‑Procedure Monitoring and Recovery:
- Vital signs continue to be monitored.
- Patient is discharged once fully awake and anesthesia has worn off.
This procedure plays a crucial role in reducing low back pain and improving quality of life. Patients typically experience rapid recovery and return to normal activities quickly.
Potential Side Effects and Precautions
While effective, radiofrequency treatment can have side effects, usually mild and temporary. Practitioner experience significantly reduces their frequency and severity. Common side effects include:
- Infection at the injection site
- Bleeding or bruising
- Temporary discomfort or pain at the injection site
- Rarely, nerve injury
As with any treatment, risks should be carefully evaluated beforehand. Physicians take precautions to minimize complications, and patients should monitor for any post‑procedure symptoms.
Contraindications for Pulsed Radiofrequency Treatment
Pulsed Radiofrequency (RF) therapy may not be suitable for certain patients:
- Active infections at or near the treatment area.
- Bleeding disorders or use of anticoagulant medications.
- Allergy to local anesthetics or other procedural components.
- Pregnant women or those suspected to be pregnant.
- Severe psychological or cognitive impairments preventing cooperation.
These conditions pose serious risks, so treatment suitability must be individually assessed by a physician.
Patients Eligible for Epidural and Transforaminal Injections
These methods are particularly effective in early or advanced disc herniations and associated nerve root edema. Most patients experience significant or complete pain relief. Because of their low risk, they are generally safe. They are ideal for:
- Patients not adequately helped by medication.
- Those unresponsive to exercise and physical therapy.
- Patients seeking alternatives for cervical and thoracic disc herniations.
Injections may be repeated up to three times; if one injection is insufficient, the treatment can be repeated. Eligible patients typically feel marked relief and resume active daily lives. Procedures must be performed under physician supervision in appropriate medical settings. The most effective drug is depot corticosteroid, with minimal systemic but strong local effects, often combined with short‑ and medium‑acting analgesics. If corticosteroids are used, a 10‑day salt and sugar restriction is recommended.
- Sacral injection (caudal)
By entering the canal through the distal sacral hiatus, multiple leg and hip nerves can be treated simultaneously, especially effective for lower lumbar herniations.
- Sacral epidural catheter with adhesiolysis
Using a catheter via the sacral hiatus, injections can reach epidural space and paraspinal tissues, treating postoperative adhesions and allowing pulsed RF in the canal.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
Vaka Örnekleri