Denervation (thermocoagulation)

Targeted pain management for joint and spinal conditions

Chronic joint or back pain can severely limit daily life—regardless of whether the symptoms are caused by osteoarthritis, overuse, or degenerative changes in the spine. Conservative treatments are often tried first: physical therapy, targeted muscle strengthening, adjusting physical activity levels, medication for pain and inflammation, or injection therapies. If these approaches do not provide sufficient and lasting pain relief, many patients are faced with the question of whether surgery must be the next step.

Denervation ( radiofrequency thermocoagulation) is a minimally invasive option for treating chronic, clearly localized pain—particularly in the small vertebral joints (facet joints), the sacroiliac joint (SIJ), and, in select cases, the knee, hip, or shoulder. The goal is to specifically reduce pain transmission, improve mobility, and, in many cases, buy time to consistently implement further conservative and regenerative treatments. At ROC Ortho in Aschheim near Munich, denervation is integrated into a structured, comprehensive diagnostic and therapeutic approach.

Radiofrequency Thermocoagulation: How Does the Procedure Work?

Denervation is usually performed using radiofrequency thermocoagulation (RF). A probe is guided near the target nerve through a very thin, specialized cannula. This probe generates high-frequency electrical impulses that produce heat at the tip of the probe. The heat acts locally on the surrounding tissue, particularly on the pain-conducting nerve fibers.

Depending on the technology, a distinction is made between various RF procedures, for example:

• Continuous radiofrequency (thermal RF): targeted heating, typically in the range of approximately 60–90 °C, depending on the region, protocol, and target structure
• pulsed radiofrequency (pRF): lower temperature peaks, more of a neuromodulatory effect, often used in specific clinical settings

The appropriate method depends on the diagnosis, the target area, and the individual situation.

Important to note: Denervation addresses pain transmission, not the underlying cause of osteoarthritis or the structural changes themselves. However, it can create a “therapeutic window” during which increased movement and exercise become possible again—and it is precisely this window that is often crucial.

Who is denervation suitable for?

Denervation is particularly appropriate when the following conditions are met:

• The pain can be clearly localized (for example, near a joint or at specific vertebral joints).
• Conservative treatment has already been administered, but it has not produced sufficient or lasting results.
• The source of the pain can be narrowed down through diagnostic testing, ideally using clinical examination, imaging, and diagnostic nerve blocks.
• People often want to postpone surgery or, if possible, avoid it altogether.

Typical applications

Facet Joint Pain of the Spine
Facet joints can cause chronic back pain, particularly in the lumbar spine (and sometimes in the cervical spine as well). If the pain is mechanically triggered (e.g., during extension movements or prolonged standing) and the clinical findings are consistent, denervation may be considered as a minimally invasive treatment option.

SI Joint Pain (Sacroiliac Joint)
The SIJ—which is often overlooked—can cause significant chronic pain in the lower back and pelvic region. If symptoms are typical and a diagnosis is confirmed, denervation can provide significant relief.

Knee Osteoarthritis
In cases of knee osteoarthritis, the nerve branches that transmit pain around the joint can be treated if pain persists despite physical therapy, weight management, injections, or orthopedic interventions.

Hip Osteoarthritis
In certain cases, denervation can serve as an interim solution to reduce pain and stabilize function—especially when joint replacement is not currently desired or medically necessary.

Shoulder/AC Joint
Targeted treatment of pain-transmitting structures can also be helpful for the shoulder when there is a clear indication.

When is denervation generally not recommended?

Not all pain can be treated with denervation. Denervation is typically less suitable when:

• the pain is diffuse and cannot be definitively attributed to a specific structure
• there is an acute infection or inflammatory condition of the skin or soft tissues in the treatment area
• when there is marked instability, severe malalignment, or significant neurological symptoms, in which case other procedures take precedence
• Acute nerve root problems are the primary concern (e.g., severe radicular pain with neurological deficits)—in such cases, other treatment approaches (e.g., targeted nerve root therapies) should be considered based on the findings
• there is a structural condition in which surgery is clearly medically indicated and denervation is expected to have only a very limited effect

The most important step: an accurate diagnosis

The success of denervation depends entirely on the diagnosis. At ROC Ortho, we therefore conduct a systematic evaluation before performing denervation:

• What is the pain profile (during activity, at rest, throughout the day, triggers)?
• What clinical findings suggest a specific target structure?
• Which imaging modality is appropriate for the patient's symptoms (e.g., X-ray, MRI, ultrasound—depending on the clinical question)?
• Are there any differential diagnoses that should be addressed first (muscles, tendons, nerves, intervertebral discs, inflammation)?

When it comes to back pain, it is especially important not to treat the condition “blindly,” but to identify the source of the pain as accurately as possible.

The Denervation Procedure – Step by Step

1) Preparation

• Before the procedure, relevant factors are assessed, in particular:
• current medications (e.g., blood thinners—individual medical instructions apply here)
• Concomitant conditions and prior medical history
• Target region, access, and image verification

2) Procedure (outpatient)

• The procedure is usually performed on an outpatient basis. The typical steps are:
• Positioning based on the target region (prone, supine, or lateral position)
• Disinfection and sterile draping
• local anesthesia at the injection site
• Millimeter-precise positioning of the RF needle under image guidance
• Test simulation (depending on the region) to verify the position
• Performing the radiofrequency treatment according to protocol
• Repeat on adjacent target branches if medically necessary
• Many patients describe the procedure as uncomfortable but well-tolerated. General anesthesia is usually not necessary.

3) Follow-up

• This is followed by a brief monitoring period. You will receive information on:
• Rest and Gradual Increase in Activity
• What to do on the day of treatment (e.g., driving, depending on your individual situation)
• possible temporary irritation during the first few days
• appropriate follow-up care (physical therapy, exercise, and additional treatment steps if necessary)

Videos on Denervation

How quickly does it take effect—and how long does it last?

The timeline may vary from person to person. Generally speaking:

• In the short term, the area may feel sore as a result of the procedure (similar to "muscle soreness")
• For many patients, the actual pain relief sets in within a matter of days to a few weeks
• The duration of the effect is limited, as nerves are capable of regenerating— ranging from several months to several years —depending on the diagnosis, activity, concomitant therapy, and progression of the underlying disease.

Important: Denervation is particularly effective in the long term when the resulting pain relief is used for:

• targeted muscle building
• Improving mobility and stability
• Adjusting Workload and Ergonomics
• where appropriate, regenerative or orthobiological treatment components, if medically indicated

Benefits of Denervation

Denervation has several clear advantages:

• Minimally invasive procedure with a small skin incision
• can be performed on an outpatient basis
• Targeted treatment of specific pain-conducting nerve branches
• General anesthesia is usually not required
• can reduce pain if treatment is successful
• can create better conditions for exercise, physical therapy, and muscle building
• can be combined with other conservative treatment methods

Limitations, Side Effects, and Risks

A serious text also needs to set boundaries. Possible, mostly temporary side effects include:

• Tenderness at the injection site
• local hematomas
• temporary increase in pain due to tissue irritation
• Temporary tingling or numbness in the treated area (depending on the region)
• Rare risks (depending on the region and anatomy) may include:
• Infections (rare despite the use of sterile techniques)
• Damage to adjacent structures
• long-lasting sensory disturbances

At ROC Ortho, we work to minimize risks as much as possible through standardized procedures, sterile techniques, and precise image guidance. Careful assessment of the indication is also crucial: not every type of pain should be treated with denervation.

Denervation as part of the overall treatment plan at ROC Ortho

At ROC Ortho, we do not view denervation as an isolated pain treatment. First, we determine which structure is likely causing your symptoms and whether the pain-carrying nerve branches are suitable candidates for denervation.

To this end, we correlate your symptoms and the clinical examination findings with existing imaging data and—if necessary—targeted diagnostic infiltration. Only once these findings are consistent do we discuss with you whether denervation is medically appropriate and what alternatives are available.

For us, treatment doesn’t end with pain relief after the procedure. Once the symptoms subside, this window of opportunity can be used to further build up mobility, muscle strength, and endurance in a targeted manner—for example, in collaboration with ROC Physio.

Once pain has been successfully relieved, there are usually two primary goals:

1. Restore function: more mobility, greater resilience, greater safety in daily life
2. Reducing the risk of relapse: through stabilization, strength, mobility, and appropriate adjunctive therapy

Depending on the situation, the overall concept may include components such as:

• Targeted physical therapy and active training
• Infiltration therapies (diagnostic or therapeutic)
• Orthopedic devices and load management
• regenerative/orthobiological procedures, when medically indicated (not as a substitute for diagnosis, but based on specific indications)

Frequently Asked Questions About Denervation