Is It Safe to Have an Ablation for Back Pain If I Have a Bleeding Disorder?

Q: I have back pain from scoliosis, but I also have a bleeding disorder. Is it safe to have radiofrequency ablation?

A: Back pain is a common symptom in patients with scoliosis. When pain is not effectively relieved by other treatments such as physical therapy and medication, your doctor may recommend radiofrequency ablation.

Radiofrequency ablation is generally at low risk for bleeding issues, but patients should disclose any history of bleeding disorders and anticoagulant use with their provider to develop an appropriate treatment plan.

Radiofrequency ablation is a minimally invasive procedure, which means it does not require a large incision (a cut in the skin made by a surgeon during an operation), is less invasive than other procedures (such as open surgery), and recovery time is much faster.

Patients taking anticoagulants (medicine to prevent harmful blood clots) or those with bleeding disorders, such as von Willebrand disease, are at higher risk for bleeding during some invasive procedures.

Blood clotting is necessary to stop bleeding from wounds and cuts. Some conditions, such as atrial fibrillation, can cause blood to thicken and clot too quickly. Anticoagulants help thin the blood, so it doesn’t clot as easily. Physicians will sometimes tell patients to stop taking anticoagulant medicine before surgery to prevent bleeding during or after an operation.

When used for scoliosis, radiofrequency ablation works by cauterizing (burning) part of the nerve or nerves in the spine responsible for causing the pain. The physician first numbs the skin on the spine where the treatment will be done. Numbing the skin prevents the patient from feeling any pain in that area during the procedure. Next, a very small cannula (tube) is inserted through the skin and into the spine. A special type of x-ray (fluoroscopy) is used to help the physician see the area better. Heat is then sent through the cannula to burn part of the nerve.

Because the area of the spine treated with radiofrequency ablation is not near any major vessels, the risk of bleeding is low. Your physician will discuss any concerns you have during your evaluation.

The most common question we get asked about radiofrequency ablation is if burning the nerves can cause any side effects, such as problems with moving the legs. The nerves treated aren’t involved with movement; they are mostly responsible for controlling pain, which is why we can do this procedure.

After the procedure, patients experience about one to one and a half years of relief from spine pain. The nerves that cause pain do grow back, but they grow back slower and weaker. We can repeat the procedure for some candidates and provide longer pain relief.

Our experts can give you a complete evaluation. This means we consider all options that may help manage your scoliosis. You want to choose a medical center that will give you individualized care that meets your needs and provide many options so you can choose what is best for you.

Epidural steroid injection is another minimally invasive procedure for treating back pain. This procedure is done by the physician injecting steroid medicine into the joints of the spine. Steroids reduce swelling and help relieve pain caused by swelling. Patients having an epidural steroid injection are evaluated closely to make sure they are not at increased risk of bleeding into the spine.

If you have any concerns about scoliosis or other spine conditions, contact us here at the spine center. We are happy to help you find the best treatment available.

• Kai-Ming Fu, director of spinal conditions and scoliosis, and Dr. Daniel Pak, double-board-certified in anesthesiology and pain medicine

This question was answered during the episode of Spine Time called “Scoliosis: When Is Surgery an Option?” A recording of this webinar held on December 2, 2020, is available on YouTube.