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Q: My doctor was using the term ‘ablation’ about my options for treatment. What is that, and when does it come into play?

A: Ablation refers to the ways we are able to calm — or destroy — something that may be causing a problem in the body. In the heart, for example, parts of the tissue can be ablated to correct abnormal electrical signals that are causing an arrhythmia. Ablation is also a commonly used technique in pain management, where we use electrical energy to generate heat through a needle that is then applied directly to a nerve to to quiet it down. When we’re using ablation, we are almost at the point of destroying that nerve; it’s generally done on a sensory nerve whose role is just to sense pain and not control movement of the legs or arms.

We most commonly use ablation in the facet joints, but it can also be done in the shoulder, hip, and knees, where we know there are tiny nerves that detect pain in the joint. Ablation techniques can also be used in patients who develop painful arthritis.

We don’t want to do anything destructive to something vital, so when we do ablation, we take time to test the nerves we’re targeting. That entails stimulating the target nerve and making sure it is not one that moves the arm or leg (known as a motor nerve). The ablation tries to just slow down the rate of signals coming out from that painful area towards the spine and then to the brain. We can then make a decision to make sure we’re really focused on a sensory nerve and not a motor nerve.
– Dr. Neel Mehta, Pain Medicine Specialist

This question was answered during the episode of Spine Time called “It Didn’t Work the First Time: What is ‘failed back syndrome’ and what can be done about it?” A video of that episode, held on July 8, 2020, is available on YouTube. To sign up for future episodes of Spine Time, where you can ask questions of our spine specialists, subscribe here.