Thoracic Radiofrequency Denervation

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

This procedure can be used when thoracic facet joints have been confirmed as the source of mid-back pain, typically by a good response to diagnostic medial branch blocks, and where that relief was only temporary. It is relevant for chronic facet-mediated thoracic 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 for thoracic radiofrequency denervation is more limited than for the cervical and lumbar regions, and honesty about this is important. A systematic review and meta-analysis of thoracic medial branch blocks and radiofrequency neurotomy, together with several cohort studies, suggest that the procedure can provide meaningful relief for carefully selected patients with confirmed facet pain, while noting that the overall evidence base is smaller and of lower quality than in other spinal regions. The balanced view is that, in well-selected patients, it is a reasonable option for chronic thoracic facet pain, used within a considered plan rather than as a routine step.

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 several months. If pain gradually returns as the nerves recover, the treatment can be repeated. As with any procedure there are risks, and 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.

• —Manchikanti L, et al. Effectiveness of medial branch blocks and radiofrequency neurotomy in managing chronic thoracic pain: a systematic review and meta-analysis. Pain Physician 2023. (PMID 37774177)
• —Stolker RJ, et al. Percutaneous facet denervation in chronic thoracic spinal pain. Acta Neurochir (Wien) 1993. (PMID 8333313)
• —Rohof O, et al. Radiofrequency neurotomy of medial branches including a bipolar system for thoracic facet joints. Scand J Pain 2018. (PMID 30001215)
• —Sen H, et al. Thoracic medial branch radiofrequency neurotomy using a three-tined electrode: a retrospective cohort study. Interv Pain Med 2025. (PMID 40103655)