So, you had a radiofrequency ablation for your neck or back pain, and it helped — kind of. You felt better for a while, but now the pain is creeping back… or maybe it never fully went away.

Let’s talk about why that happens, what it doesn’t mean, and most importantly — what you can do next.

💡 First, Don’t Panic

It’s not uncommon to feel incomplete relief after an RFA. This doesn’t mean the procedure “failed” — in fact, there are several very treatable reasons why your pain might still be lingering.

🕒 1. The RFA Might Be Wearing Off

RFA isn’t forever. The nerves we target during an RFA can regrow over time — usually in 6 to 18 months. If you had good relief early on, but the pain is returning months later, this is a strong clue that the nerves are regenerating.

📌 Good news: You may be a perfect candidate for a repeat RFA.

We often see even better results the second time around, especially if your pain returned slowly after initial relief.

🧩 2. It Might Not Be the Only Source of Pain

The spine is complex — and pain rarely comes from just one place.

Even if we correctly treated one pain generator (like the facet joints), there may be other contributing factors, including:

  • Disc pain
  • Sacroiliac joint dysfunction
  • Nerve root inflammation or compression
  • Muscular or ligamentous strain

📌 What to do next: We’ll re-evaluate your imaging, your physical exam, and consider targeted diagnostic injections to help map out any other sources.

🔥 3. You May Need a Stronger, Longer-Lasting Option: Surgical Rhizotomy

If you’ve had an RFA and the pain keeps coming back — or never fully went away — it might be time to level up. That’s where a surgical rhizotomy comes in.

Think of it as the next step up from a traditional RFA: more precise, more permanent, and better suited for certain patients who need a deeper solution.

So, What Is a Surgical Rhizotomy?

A surgical rhizotomy is a more advanced, interventional procedure that targets the same medial branch nerves treated during an RFA — but in a more durable and definitive way.

Rather than just applying heat through a probe, this procedure involves:

  • Visualization of the facet joint region
  • Use of a trephine or small surgical instruments to cut the sensory nerve branches
  • Use of a bipolar electrocautery device for controlled, thorough ablation of the sensory medial branch nerves

By physically disrupting or even removing a portion of the nerve pathway, we prevent regrowth and extend the duration of pain relief — often many years, and in some cases, permanently.

Is It Invasive?

Not in the way most people imagine. While technically “surgical,” a rhizotomy is usually:

  • Outpatient or same-day procedure
  • Done under local anesthesia with mild sedation
  • Performed through a small incision, using fluoroscopic (X-ray) guidance

It’s not a spinal fusion. There’s no metal hardware. It’s still minimally invasive, just more powerful.

Who Should Consider It?

You may be a candidate for surgical facet rhizotomy if:

  • You’ve had multiple RFAs with short-term relief
  • You have confirmed facet-mediated pain and want a more permanent fix
  • You’re not getting the relief you need — but want to avoid major spine surgery

Many patients who felt only temporary relief from RFAs go on to have dramatic, lasting results from a surgical rhizotomy.

What’s Recovery Like?

Most patients are back to normal activities within a few days. You may have mild soreness at the incision site, but nothing like the recovery from traditional spine surgery.

And best of all: you can finally move without that deep, aching, stiff pain that’s been dragging you down for months (or years).

🧠 Bottom Line: There’s Always a Next Step

Pain after RFA isn’t the end of the road — it’s a sign to dig deeper.

Whether the nerves are growing back, we need to investigate other pain sources, or it’s time to consider a more definitive treatment, you don’t have to settle for “just okay.”

🩺 Still in Pain? Let’s Talk.

If you’ve had an RFA for back or neck pain and you’re still feeling it, we want to hear from you.

📍 Visit us on the Upper East Side

🔍 Searching for a spine specialist near me? You just found one.

📞 Call or text us today at 917-694-2212

🗓️ Or request your appointment at https://practice.kareo.com/uespain

Your pain is valid. Your options are real. Let’s find what works — together.