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Fluoroscopy-guided spine procedure

Cervical Facet Radiofrequency Ablation

If your neck pain comes from the small joints in your cervical spine — not from a pinched nerve running down your arm — this is the procedure I reach for. Heat to quiet the tiny nerves carrying the pain signal. Months to over a year of relief.

Time in the room
30–45 minutes
Sedation
Optional, ASC only
Recovery at the center
About 30 minutes
Typical relief duration
6–18 months

What I'm doing

Quieting the pain pathway in your neck

Your cervical spine has small joints — facet joints — at every level. They wear down with age, whiplash, and repetitive loading. When they hurt, the pain shows up as deep, axial neck pain that gets worse with extending or rotating your head. The pain travels through tiny nerves called medial branches.

Cervical facet RFA uses controlled heat to interrupt those medial branch nerves at the cervical levels. The joints stay. The arthritis stays. The pathway carrying the pain signal up to your brain is what changes.

Before I do an RFA, I almost always do diagnostic medial branch blocksfirst — usually two on separate days. I numb the same nerves with a temporary anesthetic. If the blocks give you significant relief, the facets are the source and RFA will likely help. If they don't, RFA isn't the right tool and we should look elsewhere.

The cervical level is technically more demanding than the lumbar — the medial branches sit very close to vertebral arteries and the spinal cord. I do every cervical RFA under live X-ray with sensory and motor testing before each treatment, never blind. Same caution I apply to cervical epidurals.

And I'll be straight with you: not everyone responds to RFA, even after positive diagnostic blocks. Most patients do — but a real fraction don't get the relief they hoped for. That's biology, not failure on either of our parts.

Medical illustration of facet joint anatomy and the small medial branch nerves above and below each joint.
The same anatomical principle as lumbar facet RFA — only at the cervical level. RFA targets the medial branch nerves that carry pain signals from each facet joint, leaving the joint itself intact.Illustration: Blausen Medical Communications · CC BY 3.0

Honest expectations

What this can do — and what it can't

What this can do for you

  • Long-lasting relief — typically 6 to 18 months from a single treatment.
  • Often cuts or eliminates the need for daily neck pain medication.
  • Lets you turn your head, sleep, and work without constant background pain.
  • Minimally invasive — needles only, no incision, same-day discharge.
  • Repeatable. The nerve regenerates over time, and we can treat again when it does.

Risks I'll be honest about

Most are manageable, and I take specific precautions at the cervical level.

  • Soreness and muscle aching at the treatment sites for several days(common)
  • Temporary numbness or skin sensitivity in the treated area(common, fades)
  • Brief flare of usual pain in the first week(occasional)
  • A small percentage of patients don't get the expected relief(uncommon but real)
  • Infection at needle sites(rare)
  • Vascular injury near the medial branch — the reason I use live X-ray and testing(very rare)
  • Nerve injury affecting movement (medial branch is sensory only)(very rare)

Other options

Things we could try instead, or alongside

  • Repeat cervical facet injection

    A direct steroid into the facet joint can give weeks to a few months of relief.

    Where this fits: When you've responded well before and want a familiar, lower-commitment option.

  • Physical therapy + postural retraining

    Deep cervical stabilizer training and postural work often reduces facet loading.

    Where this fits: Always — usually as the long-term plan.

  • Cervical epidural injection

    If your imaging or symptoms also suggest a pinched nerve (arm pain, numbness, tingling), an epidural targets a different problem.

    Where this fits: When pain shoots down an arm — that's nerve-root, not facet.

  • Anti-inflammatory medications

    NSAIDs (ibuprofen, naproxen, meloxicam) can dial down facet inflammation.

    Where this fits: First-line, especially during a flare.

  • Surgical consultation

    If imaging shows instability or severe stenosis that won't be fixed by quieting nerves, surgery may be the right move.

    Where this fits: When conservative + interventional care has failed and imaging clearly explains the symptoms.

Before your visit

How to get ready

One thing I want you to know first

You will not be put to sleep for this.A lot of patients walk in expecting general anesthesia — that's not what happens here. If we're using conscious sedation (only at the surgery center, only in select cases), you'll get a relaxant through an IV that takes the edge off. You'll still be awake. You'll still be able to talk to me. You just won't be anxious. Most patients say it felt easier than they imagined.

Bring a driver

You need someone to drive you to and from the procedure. This is non-negotiable, even without sedation. You may feel unsteady or have temporary numbness in a limb after the injection, and I don't want you behind the wheel.

Eating and drinking before

Standard fasting rules if we're doing sedation: no solid food for 8 hours before your start time. Clear liquids (water, black coffee, apple juice) are OK up to 2 hours before. If we agreed to do this without sedation, eat normally.

Take your morning medications

Take your usual meds with a small sip of water on the morning of the procedure — especially blood pressure medications. If your blood pressure is elevated when you arrive because you skipped your meds, I will likely have to cancel and reschedule. That's not what either of us want. The only exception is if I've specifically told you to hold a particular medication. When in doubt, take it.

Blood thinners — talk to me first

Most blood thinners need to be paused before this procedure. I'll go over the specific timing with you, but here's the general guidance — never stop or change anything without checking with me or the doctor who prescribed it:
  • • Aspirin (81 mg) — usually OK to continue. I'll tell you if I want it held.
  • • Plavix (clopidogrel) — typically held 5–7 days before
  • • Eliquis (apixaban) — typically held 24–48 hours before
  • • Xarelto (rivaroxaban) — typically held 24–48 hours before
  • • Pradaxa (dabigatran) — typically held 24–72 hours, depending on kidney function
  • • Warfarin (Coumadin) — typically held until INR is below 1.5
  • • Lovenox (enoxaparin) — typically held 12–24 hours
There are situations where I'll keep you on a blood thinner because the risk of stopping outweighs the bleeding risk of the injection — recent stent, atrial fibrillation with high stroke risk, etc. We'll make that call together.

Tell me about your allergies

Before the procedure, tell me about every allergy you have, especially to contrast dye, local anesthetics (lidocaine, bupivacaine), steroids, latex, or shellfish/iodine. If you've ever had a reaction to a CT scan with contrast, that matters for fluoroscopy procedures.

What to wear

Loose, comfortable clothing. You'll be changing into a gown for the procedure but will need to dress yourself afterward, and tight jeans or a fitted dress is harder when one leg feels heavy. Skip the lotion or perfume on the area being injected.

The day of

Step by step, what actually happens

The whole appointment runs about 1.5–2 hours. The procedure itself takes 30–45 minutes since I'm treating multiple nerves at multiple levels.

  1. 1

    Arrival and check-in

    You'll come in with your driver, finish paperwork, change into a gown, and a nurse will start an IV.

  2. 2

    I see you before we start

    I'll go over the plan and which levels we're treating, answer questions, confirm consent.

  3. 3

    Into the procedure room

    You'll lie face down on the procedure table with your forehead supported. The C-arm sits over your neck, with a monitor beside it.

  4. 4

    Numbing the skin

    I'll inject local numbing medication at each treatment spot. Brief stinging, then it goes numb.

  5. 5

    Positioning the probes

    Using live X-ray, I guide thin RF probes to each medial branch nerve at the cervical levels we're treating. I test each placement first with a brief electrical pulse — sensory then motor — to confirm I'm at the right nerve and not too close to a major motor branch.

  6. 6

    The treatment itself

    Once each placement is verified, the probe heats the nerve to about 80°C for 60–90 seconds. You'll feel deep warmth and pressure, sometimes a brief reproduction of your usual neck pain. I treat both sides at the targeted levels.

  7. 7

    Recovery

    About 30 minutes in recovery — vitals, snack, walking around. Then your driver takes you home. You'll be sore.

Fluoroscopy procedure room with C-arm.
Live X-ray + sensory and motor testing at every level — non-negotiable for cervical RFA.Photo: KH St Elisabeth Ravensburg via Wikimedia Commons

After

The recovery you should plan for

Days 1–5: the sore phase

Expect deep aching at the treatment sites — like a sunburn buried inside your neck. Ice 15–20 minutes a few times a day. Your usual neck pain medication for breakthrough discomfort. Light walking is fine; avoid heavy lifting.

Week 1–2: the transition

Soreness fades gradually. Your usual pain may still be present — this is the in-between window when the nerves haven't fully quieted yet.

Weeks 2–4: real benefit shows up

This is when most patients notice the turning point. As treated nerves stop firing, neck mobility improves and the constant background pain quiets down. Resume normal activity. Restart physical therapy.

Months 1–18: sustained relief

Most patients enjoy 6 to 18 months of meaningful improvement. The nerves slowly regenerate over time — and when they do, we can repeat. Repeat RFAs usually work as well as the first.

When to call me right away

  • Severe new weakness in your arms or legs

    If a limb feels significantly weaker than before — trouble lifting it, dragging a foot, dropping things — that needs attention now.

  • Loss of bladder or bowel control

    Sudden trouble holding it or sudden trouble going. Rare, but a true emergency. Go to the ER, then call me.

  • Fever above 101°F (38.3°C)

    A fever in the days after the procedure, especially with chills, can mean infection.

  • Spreading redness, warmth, or drainage at the injection site

    Some bruising and tenderness is normal. Pus, increasing redness expanding outward, or yellow drainage is not.

  • Severe new pain that's worse than before

    Brief soreness for a few days is expected. Sharp, severe new pain different from your usual is not.

  • Severe new arm weakness or trouble swallowing

    Cervical-specific red flag. Rare, but a true emergency. Go to the ER, then call me.

For anything that worries you, call my office. I'd much rather hear from you and tell you it's fine than have you wait at home wondering. For loss of bladder/bowel control or anything that feels like a true emergency, go to the nearest ER — then call me.

The questions I get most

Frequently asked

Will I be put to sleep?
No. I need you alert during the testing phase so you can tell me what you feel — that's how I confirm the probes are at the right nerves.
Why do you do the nerve blocks before the RFA?
The blocks tell us whether the facet joints are actually the source. If a temporary numbing medication doesn't give you significant relief, a longer treatment of those same nerves won't either. The blocks save you from going through a procedure that won't help.
Is cervical RFA riskier than lumbar RFA?
Slightly more demanding because the medial branches are close to important structures. That's exactly why I use live X-ray plus sensory and motor testing at every level. In trained hands, the procedure is safe and effective.
How quickly will I feel better?
The first few days are usually MORE sore. Real improvement shows up around weeks 2–4. Don't panic on day three.
How long does the relief last?
Most patients get 6 to 18 months. The nerves regenerate over time, which is by design and why repeats work.
What if it doesn't work?
A small fraction of patients don't respond even after positive diagnostic blocks. If that's you, we go back to the drawing board — different imaging, different procedure, or a different working diagnosis.
Can I have it more than once?
Yes. The nerves regenerate over months to a year, and when pain comes back, we can repeat. Most patients get a similar duration of relief from the second and third rounds.
Can I drive myself home?
No. Bring a driver. You'll be sore, and if we used sedation, you're not driving for the day.

Have Questions?

If you'd like to learn more about your treatment options or have a question for Dr. Patibanda, reach out.

Contact Dr. Patibanda