In 1897, Mark Twain was on a speaking tour in London when an American newspaper started a rumor that he was gravely ill. This was soon followed by an obituary. When asked by an American reporter in London about his death, Twain quipped, “The reports of my death have been greatly exaggerated.” I feel the same about C1-C2 facet injections. The radiofrequency mob has been trying hard to kill off cervical facet injections for years and C1-C2 is low hanging fruit, but like Twain, I have to report the death of this procedure has been greatly exaggerated.
What is a Facet Joint and how Does RFA Work?
Sometime around the turn of this last century, we began to see the use of radiofrequency ablation (RFA) for neck pain due to damaged facet joints take off. What is RFA and what is a damaged facet joint?
You have 14 joints in the back part of your spine (7 on each side). These joints help to control neck motion. These little articulations about the size of a finger joint are commonly called “facet joints”. They can become injured or can get arthritis like any other joint in your body. When this happens they can become chronically painful.
While the injection of anti-inflammatory steroid into these joints was the most common way to treat this pain, about 2000 or so we began to see the rise of another form of treatment called RFA. This procedure uses a probe that heats up to burn away nerves around the painful joint. The idea is that once these pain carrying “wires” are “cut”, the pain will stop because it’s no longer being transmitted to the brain. This works pretty well and has been well researched to help chronic neck pain caused by a damaged facet joint. However, as you might imagine, you can’t just burn nerves that carry pain signals and not have consequences. This procedure can cause the joint to become more damaged (a Charcot joint) and in my experience can cause a cycle where the patient needs to be treated every 5-18 months forever. In addition, my personal observation is that these patients get more “brittle” with time. By that, I mean that when their pain returns it’s worse and easier to provoke than before RFA was begun.
The RFA Biz Plan
Radiofrequency is a great medical business. Not only do these patients need to come back every so often for a repeat treatment, but insurance companies pay more for RFA than a simple facet injection. In addition, there’s a third party vendor who gets to charge outrageous prices for disposable needles and new RF probes, which means that there’s lots of moolah around to sponsor conferences, pay physician thought leaders, and medical directors. Hence, knowing that money talks in medicine, it’s not hard to figure out why those thought leaders have been trying to get rid of facet injections (i.e. injecting a substance into the joint rather than burning the nerves around the joint). as the idea competes with RFA. However, with the advent of orthobiologics like PRP and stem cells, everything changes.