Radiofrequency Ablation for Lumbar Facet Pain
Criteria for Medical Necessity
- The American Society of Anesthesiologists recommends that patients with severe pain limiting activities of daily living for at least 6 months (VAS score of 7/10) are candidates for lumbar RFA 1
- Patients who have not had prior spinal fusion surgery at the level to be treated are eligible for lumbar RFA, according to the Journal of Neurosurgery guidelines 2, 3
- Neuroradiologic studies should not confirm disc herniation, and there should be no significant narrowing of the vertebral canal or spinal instability requiring surgery, as recommended by the Journal of Neurosurgery 2, 3
- The American Society of Anesthesiologists suggests that patients should try and fail six or more weeks of conservative treatments, including home exercises and stretching 4, NSAIDs 2, and heat therapy 2, 3
Previous RFA Response Supporting Repeat Procedure
- A patient who received left lumbar RFA L3-S1 with documented 75% improvement is a candidate for repeat procedure, according to the Anesthesiology guidelines 1
- The minimum requirement of >50% pain relief for at least twelve weeks is needed to justify a repeat procedure, as recommended by the Journal of Neurosurgery 2, 3
Procedural Details
- The procedure includes destruction by neurolytic agent, paravertebral facet joint nerve(s); lumbar or sacral, single facet joint (x1) and each additional facet joint (x2), as coded by the Anesthesiology guidelines 4
- Anesthesia for percutaneous image-guided destruction procedures by neurolytic agent on the spine or spinal cord; lumbar or sacral (x1) is recommended by the Anesthesiology guidelines 1
Justification for Anesthesia
- The American Society of Anesthesiologists supports appropriate anesthesia for interventional pain procedures in patients with complicating factors such as Obstructive Sleep Apnea (OSA) 1, 4