General Guideline Principles for Radiofrequency Ablation,
Neurotomy, Facet Rhizotomy for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Radiofrequency Ablation, Neurotomy, Facet Rhizotomy.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Radiofrequency Ablation, Neurotomy, Facet Rhizotomy of Therapeutic Procedures

A technique intended to ablate the relevant sensory medial branches to denervate the facet joint. The technique most frequently employed is continuous percutaneous radiofrequency.

It is advised that microwave medial branch neurotomy be used instead of alcohol, methanol, other injectable substances, or cryoablation.

For the probe to be positioned precisely, fluoroscopic guidance is necessary.

To confirm where the device should be placed, permanent photos should be taken.

  1. Radiofrequency Ablation, Neurotomy, Facet Rhizotomy of Therapeutic Procedures
    Radiofrequency Ablation, Neurotomy, Facet Rhizotomy of Therapeutic Procedures are recommended clinically appropriate in a subset of patients.


    • Radiofrequency ablation, neurotomy, and facet rhizotomy may be recommended for patients having proven facet joint discomfort in whom two diagnostic medial nerve branch blocks have been therapeutically effective.

    • If there are more than Mid and Behind Injury, the technique is not advised (four medial branch nerves).

    • Both a diagnostic medial nerve branching block and a second comparative block should be successful in treating all patients.

    • For a diagnostic block to be considered positive, the patient must report a pain reduction of at least 50% from start for the duration recommended by the local anesthetic employed, which should be connected with functional improvement.

    • The individual should also list the everyday activities (which may involve range-of-motion assessments).


  2. Post-Procedure TherapyPost-Procedure Therapy is recommended in a few cases when clinically necessary.
    • Barring difficulties, starting a mild reconditioning program within the first postoperative week is advised.

    • Training and involvement in a tall home-based program of strengthening of the cervical, scapula, and thoracic regions, range of motion endurance, stability, and neuromuscular re-education.


  3. Repeat Radiofrequency Neurotomy (or additional level radiofrequency neurotomies)Repeat Radiofrequency Neurotomy (or additional level radiofrequency neurotomies) isrecommended in select patients
    • Pain may come back occasionally.

    • A successful rhizotomy typically brings about alleviation for six to nine months.

    • If the patient’s pain pattern manifests differently than it did during the original evaluation, a confirming medial branch injection may be carried out before a repeat radiofrequency neurotomy.

  4. Dorsal Root Ganglia Radiofrequency Lesioning

    Dorsal Root Ganglia Radiofrequency Lesioning is not recommended for persistent sciatica because there is no evidence that the hazards of this intrusive technique exceed the advantages.


  5. Intradiscal Electrothermal Therapy (IDET)

    Intradiscal Electrothermal Therapy (IDET) is not recommended for the treatment of any back-related condition, including acute or chronic back pain.


  6. Percutaneous Intradiscal Radiofrequency Thermocoagulation (PIRFT)

    Percutaneous Intradiscal Radiofrequency Thermocoagulation (PIRFT) is not recommended for the treatment of back pain, particularly discogenic back pain, whether it is acute or not.


What our office can do if you need Radiofrequency Ablation, Neurotomy, Facet Rhizotomy

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.


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Dr. Nakul Karkare

I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

You can see my full CV at my profile page.