Ablative and Regenerative Techniques
Core concepts
Radiofrequency ablation (conventional, cooled, pulsed) targets medial branches for facet-mediated pain, genicular nerves for knee pain, and other named nerves. Regenerative approaches include platelet-rich plasma and prolotherapy; evidence varies by indication, and patient selection matters.
Patient selection and technique
For medial branch radiofrequency, the standard sequence is concordant diagnostic blocks followed by lesioning. Understand lesion size, temperature, and duration relationships, and why cooled RF produces larger lesions. Pulsed RF is non-destructive and used where thermal injury is undesirable.
Traps
- Proceeding to RF without validated diagnostic blocks.
- Assuming pulsed RF produces thermal ablation.
- Overstating regenerative evidence; know which indications have support.
- Overlooking denervation-related complications (e.g., neuritis, sensory change).
Worked rule of thumb
Ablate only what you have proven: two concordant medial branch blocks with substantial relief justify RF. Document the target, lesion parameters, and expected duration of relief (often months, not permanent).
Cautions
Avoid thermal lesioning near unintended motor or sensory structures; use sensory and motor testing where appropriate.