Radiofrequency (RF) neurotomy is an interventional procedure used to alleviate certain types of low back pain. RF energy is used to thermally coagulate the specific nerves that transmit pain signals. Recent evidence has shown that this procedure demonstrates significant efficacy in relieving low back pain in lumbar zygapophysial joints, and research is ongoing to determine if pain relief for the sacroiliac joint is also possible. This article provides an evidence-based background for performing RF neurotomy, discusses the relevant anatomy, and highlights the indications and technique for lumbar and sacral RF neurotomy.