Facet joint rhizolysis / Radio frequency lesioning (Denervation)
A long-lasting treatment for facet-joint back or neck pain. Heat is applied to the small medial branch nerves that carry pain signals from the joint, interrupting them for 9–18 months and giving you a window for rehabilitation.
Led by Dr Arul James (Consultant in Pain Medicine, GMC Specialist Register) at The Vesey, Sutton Coldfield. Self-pay and insurance accepted (BUPA, Vitality, AXA, WPA, Cigna, Aviva, Healix). Same-week appointments typical.
Who this procedure is for
- Positive diagnostic medial branch block — at least 70% short-term relief, typically confirmed at two test sessions.
- Mid-line back or neck pain that is worse with extension, rotation or prolonged standing.
- You have engaged with physiotherapy and want a durable analgesic platform to make rehab stick.
- Recurrent facet pain after a previous successful denervation — typically appropriate every 9–18 months.
How the procedure is performed
Performed by Dr Arul James in our procedure suite under fluoroscopic image guidance. After local anaesthesia, a fine radiofrequency needle is placed onto each target medial branch nerve. Sensory and motor stimulation confirms safe placement, then a 60–90 second 80°C thermal lesion is created at each nerve. Typically two to four levels per side are treated. The visit is 90 minutes including recovery.
Before, during and after
- Before: light meal allowed up to 2 hours pre-procedure. Continue most regular medications; we will confirm anticoagulant plan at consent.
- During: prone position, fully awake. You will feel pressure and a brief warm/aching sensation as each lesion is created — most patients tolerate this very well.
- After: 30 minutes of monitored recovery. Expect 5–10 days of site soreness and sometimes a brief flare before relief sets in. Full effect by 4–6 weeks.
Recovery and aftercare
Back to office work next day; avoid heavy lifting for 5 days. Restart physio at 7–10 days. Most patients see meaningful relief by week 3 and durable relief lasting 9–18 months. When pain returns, the procedure is safely repeatable — the nerves regrow and so does the indication.
How soon will I feel the benefit after radiofrequency denervation? +
Expect 5–10 days of soreness at the lesion sites first. Most patients notice meaningful improvement by 3–4 weeks, with full effect by 6 weeks. Durable relief typically lasts 9–18 months.
Do I need to stop blood thinners before the procedure? +
We review anticoagulants at the consent appointment. Warfarin is usually paused 3–5 days beforehand; DOACs are typically stopped 48 hours before. Always follow the plan discussed with your clinician.
Can radiofrequency denervation be repeated? +
Yes. When pain returns as the nerves regrow — typically after 9–18 months — the procedure is safely repeatable. Many patients have two or three cycles over several years.
Will I lose sensation or muscle strength permanently? +
The thermal lesion targets pain-carrying sensory fibres. Some patients notice temporary mild numbness in the lower back or neck. This almost always resolves within weeks and permanent weakness is very rare.
Pricing at a glance
Initial consultation £260 · Bilateral two-level radiofrequency denervation from £1,650 (includes consent, image guidance, drugs, sedation if needed and written report). Insurance accepted: BUPA, Vitality, AXA, WPA, Cigna, Aviva, Healix.
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Risks and side effects
Common: short-lived increase in pain at the lesion site (5–10 days), transient skin numbness over the back. Uncommon: brief deep ache, small areas of weakness in back-stabilising muscles (recovers). Rare: thermal injury to other structures, bleeding, infection.
When this procedure is not appropriate
Negative or inconclusive diagnostic medial branch block, pregnancy, implanted cardiac device without appropriate planning, active infection, severe anticoagulation that cannot be paused.
Cost and pathway
Initial consultation £260. Bilateral two-level radiofrequency denervation from £1,650 including consent, image guidance, drugs, sedation if needed and written report.
- Open 7 days including Sundays — 8am to 8pm, no weekend surcharge
- No GP referral required — book directly with Dr Arul James
- Sutton Coldfield location — serving Birmingham, Walsall, Tamworth, Lichfield and the West Midlands
- CQC-regulated — rated 4.88/5 on Doctify from 700+ verified reviews
View the full pain management pathway →
Sutton Coldfield · Birmingham · Walsall · Tamworth · Lichfield · West Midlands · Open 7 days 8am–8pm
Open 7 days · 8am–8pm · 0121 387 3727