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 selected cases , the knee, hip, or shoulder. The goal is to specifically reduce pain transmission, improve mobility, and thereby often buy time to consistently implement further conservative and regenerative measures. At ROC Ortho in Aschheim near Munich, denervation is integrated into a structured overall diagnostic and therapeutic concept.

What does denervation mean?

In this context, the term “denervation” does not refer to the “cutting” of large nerves, but rather to the targeted treatment of fine pain-conducting nerve branches. These nerve fibers are primarily responsible for transmitting pain signals from a specific joint or spinal region to the nervous system. They do not play a central role in muscle strength or movement control.

During denervation, these pain-conducting fibers are subjected to controlled heat, causing them to temporarily stop transmitting pain signals or to transmit them at a significantly reduced level. The joint itself—that is, the bone, cartilage, joint capsule, and ligaments—remains structurally intact.

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 in the spine
Facet joints can cause chronic back pain, particularly in the lumbar spine (and sometimes in the cervical spine). If the pain is mechanically triggered (e.g., by extension movements or prolonged standing) and the clinical findings are consistent, denervation can be a very good option.

Sacroiliac Joint (SIJ) Pain
The sacroiliac joint—often overlooked—can cause significant chronic pain in the lower back and pelvic region. In cases with typical symptoms and a confirmed diagnosis, 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.

Diagnostic test infiltration: Confirmation of the target structure

In many cases, a diagnostic block (test infiltration) is performed before denervation. This involves the targeted application of a local anesthetic to the suspected pain-conducting structure.

The goal is clear:
If the nerve block clearly and consistently reduces pain (for the expected duration of the local anesthetic’s effect), this indicates that the target structure has been correctly identified. Only then can denervation be meaningfully planned as a therapeutic step.

This approach significantly increases the likelihood of success and is part of a professional process.

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

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 (small incision)
• can be performed on an outpatient basis
• no structural changes to the joint
• General anesthesia is usually not necessary
• can help reduce the need for pain medication
• can delay surgery and allow time for rehabilitation and stabilization
• can be integrated into a multimodal treatment plan (physical therapy, exercise, injections, regenerative therapies—depending on the indication)

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

Denervation is often particularly effective when it is viewed not as a “stand-alone solution” but as part of a treatment plan. Once pain relief has been successfully achieved, two goals usually take center stage:

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 (FAQ) – Short and to the Point

Is denervation painful?
The injection site is numbed with a local anesthetic. The procedure is generally well tolerated. There may be some brief discomfort.

Can you resume normal activities right away?
In many cases, you can resume light activity fairly quickly. The specific plan for gradually increasing activity depends on the area treated and the results of your examination.

Can denervation replace surgery?
It does not replace every surgery, but it can often save time and significantly reduce symptoms—especially when the underlying condition is moderate and can be actively stabilized.

Can the denervation procedure be repeated?
If pain recurs after months or years and the medical indication still exists, the possibility of repeating the procedure can be considered.

Consultation at ROC Ortho in Aschheim, near Munich

The only reliable way to determine whether denervation is appropriate for you is through a thorough orthopedic evaluation and a clear identification of the source of your pain. At ROC Ortho in Aschheim near Munich, we take the time to conduct a structured evaluation, provide a transparent recommendation, and—if appropriate—perform a carefully planned, minimally invasive procedure.