Cervical Radiofrequency Denervation

In this procedure, a specialised needle-electrode is placed, under X-ray guidance, alongside the medial branch nerves that supply the painful facet joint. Radiofrequency energy heats the tip of the electrode, creating a small, controlled lesion that interrupts the nerve's ability to transmit pain signals from the joint. Because the medial branches are purely sensory nerves to the facet joint, interrupting them does not weaken the neck. The effect is not always permanent — the nerves can regenerate over time — but relief can last many months, and the procedure can be repeated if the pain returns.

This procedure can be used when facet joints have been confirmed as the source of neck pain, typically by a good response to diagnostic medial branch blocks, and where that relief was only temporary. It is particularly relevant for chronic facet-mediated neck pain, including whiplash-associated pain, that has not settled with simpler measures. Careful patient selection through diagnostic blocks is central: the better the response to the blocks, the more likely the denervation is to help. It is not used where nerve compression or another structural problem is the main issue.

The evidence base for cervical radiofrequency denervation is stronger than for many spinal procedures. A landmark randomised controlled trial demonstrated that percutaneous radiofrequency neurotomy of the cervical facet joints can provide significant, lasting pain relief in carefully selected patients, and long-term follow-up studies have shown that relief can be restored by repeating the procedure when pain recurs. As with all such treatments, the results depend heavily on accurate diagnosis and technique. The balanced view is that, in well-selected patients with confirmed facet pain, this is one of the better-evidenced interventional options for chronic neck pain.

The procedure is performed as a day case under image guidance. Relief may take a couple of weeks to establish as the treated nerves settle, and can then last many months. If the pain gradually returns as the nerves recover, the treatment can be repeated. As with any procedure there are risks, and a period of some soreness afterwards is common; these are discussed beforehand. Whether radiofrequency denervation is appropriate depends on a confirmed facet diagnosis and the individual, and is decided with the treating team.

• —Lord SM, et al. Percutaneous radiofrequency neurotomy for chronic cervical zygapophyseal-joint pain (double-blind RCT). N Engl J Med 1996. (PMID 8929263)
• —McDonald GJ, et al. Long-term follow-up of cervical radiofrequency neurotomy for chronic neck pain. Neurosurgery 1999. (PMID 10414567)
• —van Eerd M, et al. Radiofrequency denervation in clinically diagnosed cervical facet joint pain: a double-blind RCT. Spine 2021. (PMID 33534439)
• —Sapir DA, et al. Radiofrequency medial branch neurotomy in cervical whiplash: a prospective study. Spine 2001. (PMID 11426167)
• —Smith AD, et al. Cervical radiofrequency neurotomy reduces central hyperexcitability and improves neck movement in chronic whiplash. Pain Med 2014. (PMID 24138594)