Radio Frequency Ablation (RFA) is a technique where a needle/probe is placed next to a nerve and presumably by increasing the temperature to 80 degrees Celsius, the nerve is ablated or destroyed. This technique is still the recommended choice for the medial branch nerves of the spine facet joints, as these nerves have also only very minor sensory input to the skin and minor motor or muscle function. Thus by doing RFA at this location, one does not typically see significant numbness or weakness. However, if one does RFA on a nerve such as the nerve roots or a mixed peripheral nerve, then one may experience numbness and weakness.
Pulsed Radio Frequency (PRF) technology, helps to overcome this by pulsing the radio frequency energy to the nerves, and thus with temperatures not exceeding 42 degrees Celsius, the nerves are not destroyed, and there is no numbness or weakness. The PRF gives pain control by reversibly disrupting the transmission of the pain fibers.
The mechanism, although not certain, may work similar to TENS or spinal cord stimulation, causing neural plasticity changes within the central nervous system, but with a more direct effect on the selected nerve. Theories proposed include an electric and/or magnetic field being created by the voltage fluctuations. With PRF, the voltage (45 V) is actually higher than with RFA (15-25 V), because with pulsing technology, there are intervals in which no current is applied and thus the heat is allowed to dissipate. Interestingly, gene expression within the spinal cord by activation of a protein, C-Fos, may also contribute. These resultant changes are not permanent, so repeat PRF may be required.
In summary, PRF may cause changes within the pain nerve cell membranes and inhibition of synaptic transmission and without numbness or weakness. This allows PRF to be utilized on the mixed peripheral nerves, sensory nerves, and nerve roots, whereas with traditional RFA, this would cause numbness or weakness.
COMMON EXAMPLES WHERE PRF IS UTILIZED:
1. Mixed peripheral nerves and sensory-only peripheral nerves.
2. Trigger points
3. Nerve root/dorsal root ganglion.
4. Gray ramus communicans.
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