For those with high-deductible or uninsured health plans, MDSave can be a great way to save money when purchasing a procedure in advance. Radiofrequency ablation (RFA) is a controversial treatment for chronic facet-mediated low back pain, with some studies showing “long-lasting and large-scale improvements in pain and functional limitation” while other studies show limited benefit. The number of patients receiving two lumbar facet injection procedures before undergoing RFA has increased from 51% to 59%, which may be due to physicians using more rigorous pre-RFA selection criteria. Additionally, the increased use of RFA injections and facet joints is likely due to the opioid crisis, as it is a non-opioid treatment for pain. However, like all procedures, facet injections and RFA have risks that can cause harm and, if used unnecessarily, lead to increased costs.
Unfortunately, few doctors measure outcomes for these procedures, and there is no penalty for providing ineffective treatments. Cash payment for services must be made at the time the services are provided. If insurance is presented, these prices do not apply. Preoperative laboratory tests, x-rays, pathology and diagnosis deemed necessary by the attending physician are not included. In one study of RFA conducted by Dreyfuss et al., approximately 400 patients were selected and only 15 patients whose pain was relieved by controlled blocks of the diagnostic medial branch of the lumbar zigapophyseal joints underwent RFA.
The procedure was defined as initially successful if the electrophysiologist could not induce an arrhythmia in the laboratory after RFA. In cases where the first ablation was unsuccessful (16.49% of the RFA arm), it was estimated that 29.41% entered maintenance therapy (4.85% of the total fraction in the RFA arm) and the rest had a second ablation.
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