We Should Never Be Proud of MRIs That Show Holes Burned in Patient’s Bodies…

by Chris Centeno, MD /

basivertebral nerve ablation

A new study was recently published on a new treatment for back pain due to degenerative discs. Ordinarily, I would be excited, as what’s not to like about another treatment option for back-pain patients. However, the problem with this one is that it works by blasting a hole in the vertebrae? Yep, you heard that right. Let me explain why I’m not a fan.

What Is RFA and Why Do I Now Think That It’s a Dumb Idea?

RFA stands for radiofrequency ablation. This means that a doctor places a radiofrequency (RF) probe that looks like a thick needle into the area and ablates or kills off tissue. This works by the tip of the probe emitting an RF signal that’s designed to generate heat. Usually, RFA is used to kill off nerves that are causing pain or are carrying bad signals, like in the case of a heart arrhythmia.

Why is this a bad idea? RFA is destructive. That means it works by killing tissue. Given that we now have multiple options like platelet rich plasma, advanced platelet lysates, cytokine-enriched serums, ECM products, and stem cell therapies that work by healing or rebuilding tissue, why would we want to kill tissue?

What Are Modic Changes?

Modic changes are the bright and dark areas found in the vertebrae, adjacent to the discs, on MRI in patients who have chronic low-back pain. They are signs that the bone isn’t healthy and are thought to happen because the disc has lost its ability as a shock absorber and is transferring too much energy to the bones. Hence, in older patients, you get more wear and tear than repair, and that causes Modic changes.

As we’ll see below, the authors of the new study believed that if they ablated the nerve supply of the bone, they could help patients with back pain that was being caused by the Modic changes.

The New Research

The new study is a high-level randomized controlled trial, or RCT. The authors used a specialized RF probe in patients who had pain due to degenerative disc disease. They inserted these into the vertebrae to kill off a nerve that they felt could be causing pain from damaged vertebrae. The good news is that this seemed to work to help the low-back pain. The bad news is that as the MRIs above show, they had to burn a hole in the vertebrae to do it. In fact, the authors seemed proud that there was still a sizable hole in the vertebrae months after the procedure!

What Are the Ethics of Burning Holes in Patients’ Bodies in the Age of Regenerative Medicine?

When RFA was all we had, it was a great tool. We used it in our practice to help patients with chronic neck pain due to damaged facet joints. In fact, in many ways it was revolutionary. However, it has several dark sides. One is obvious: you’re destroying tissue. In fact, the RFA docs used to love to place their probes in chicken breasts and use them to cook them from the inside! The second is not as obvious: when the pain returns in these patients because the nerve grows back, it returns with a vengeance. In fact, all of the RFA neck-pain patients we used to have got more and more brittle over time. Meaning that they would get worse and worse with each passing RFA session. I could take away their pain, often for months and occasionally 1–2 years, but with each treatment, they looked less and not more healthy.

We’ve since moved on from RFA and abandoned it as old 20th-century tech that’s not good for our patients. It’s been replaced with regenerative medicine solutions. That just makes common sense.

However, in a world where we know that orthobiologics, like PRP and stem cells, can regenerate and heal bone, what are the ethics of burning a sizable hole in a bone to kill a nerve? Is that treatment approach ethical just because a patient’s insurance company is more likely to cover an RFA treatment? Why not just inject an orthobiologic into the vertebrae?

The upshot? We shouldn’t be proud of using RF probes to burn holes in patients big enough to be observed on MRIs. In fact, we should be embarrassed by the lack of imagination that these treatments now represent in a world where regenerative therapies are becoming commonplace. As physicians, we should be telling the companies trying to make big bucks with the next RFA device, “Thanks, but no thanks. I can no longer justify burning big holes in my patients.”

Leave a Reply

Your email address will not be published. Required fields are marked *

2 thoughts on “We Should Never Be Proud of MRIs That Show Holes Burned in Patient’s Bodies…

  1. Charlie Lyons

    I have had RFA to my lumbar facet joints. Should I question my doctor about his practice in relation to your study? Unfortunately I still have chronic low back pain. Thanks for any help you can provide. Charlie Lyons

    1. Matt Hyzy DO

      Hey Charlie
      If you still have pain ?
      Perhaps consider a Regenexx doctor and candidacy form submitted to start a consultation

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
View Profile

Get Blog Updates by Email

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Select Your Problem Area
Shoulder

Shoulder

Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.

  • Rotator Cuff Tears and Tendinitis
  • Shoulder Instability
  • SLAP Tear / Labral Tears
  • Shoulder Arthritis
  • Other Degenerative Conditions & Overuse Injuries
Learn More
Cervical Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Knee

Knees

Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

  • Knee Meniscus Tears
  • Knee ACL Tears
  • Knee Instability
  • Knee Osteoarthritis
  • Other Knee Ligaments / Tendons & Overuse Injuries
  • And more
Learn More
Lower Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Hand & Wrist

Hand & Wrist

Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Hand and Wrist Arthritis
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
  • Other conditions that cause pain
Learn More
Elbow

Elbow

Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures.

  • Golfer’s elbow & Tennis elbow
  • Arthritis
  • Ulnar collateral ligament wear (common in baseball pitchers)
  • And more
Learn More
Hip

Hip

Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

  • Labral Tear
  • Hip Arthritis
  • Hip Bursitis
  • Hip Sprain, Tendonitis or Inflammation
  • Hip Instability
Learn More
Foot & Ankle

Foot & Ankle

Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Ankle Arthritis
  • Plantar fasciitis
  • Ligament sprains or tears
  • Other conditions that cause pain
Learn More

Is Regenexx Right For You?

Request a free Regenexx Info Packet

REGENEXX WEBINARS

Learn about the #1 Stem Cell & Platelet Procedures for treating arthritis, common joint injuries & spine pain.

Join a Webinar

RECEIVE BLOG ARTICLES BY EMAIL

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Subscribe to the Blog

FOLLOW US

Copyright © Regenexx 2019. All rights reserved. | Privacy Policy

*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.

Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.