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UNFINISHED - Cervical Radiofrequency ablation (RFA)

It is designed to coagulate the nerves supplying the zygoapophyseal (Z) joints at selected levels. This is to ablate any pain triggered by pathology within these joints.

Patient selection cannot be based upon imaging alone - there has been little to no correlation between radiological findings including plain X-ray, CT, and/or MRI, with patient symptoms and/or response to therapy (1).

Cervical Z joint pathology is the most common form of injury in a suspected whiplash injury. It is the cause of localised neck pain in up to 60% of patients and contributes to cervicogenic headache, particularly from C2-C3, in up to 50% (3). This is arising from the third occipital nerve. Anatomy showed in figure 1.

(NB: The third occipital nerve is a branch of the nerve from the dorsal root ganglion from C3 and provides innervation to C2-3 Z joint).

After clinical suspicion then the analgesic response to comparative medial branch blocks (MBBs) or third occipital nerve blocks (TONBs) guides whether further RFA should be undertaken.

Unfortunately, the clinical examination has been shown to add little to the certainty of a diagnosis (2).

(Who will benefit?)

(How do you select the patient - clinical symptoms/signs/examination?)

(How is the procedure performed?)

Fluoroscopically-Guided Cervical Medial Branch Thermal Radiofrequency Neurotomy has a high level of success for the correctly selected patient - with the number needed to treat for a significant reduction in pain scores at 6 months, is 2.

(What are its risks?)

(What are the contraindications?)


  1. Andrew Engel, MD, George Rappard, MD, Wade King, MMedSc, MMed(Pain), David J. Kennedy, MD, on behalf of the Standards Division of the International Spine Intervention Society, The Effectiveness and Risks of Fluoroscopically-Guided Cervical Medial Branch Thermal Radiofrequency Neurotomy: A Systematic Review with Comprehensive Analysis of the Published Data, Pain Medicine, Volume 17, Issue 4, April 2016, Pages 658–669,

  2. King, W., Lau, P., Lees, R., & Bogduk, N. (2007). The validity of manual examination in assessing patients with neck pain. The Spine Journal, 7(1), 22-26.

  3. Lord, S. M., Barnsley, L., Wallis, B. J., & Bogduk, N. (1994). Third occipital nerve headache: a prevalence study. Journal of Neurology, Neurosurgery & Psychiatry, 57(10), 1187-1190.

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