A History of the Development of Radiofrequency Neurotomy

Abstract

The technique of lumbar medial branch radiofrequency neurotomy for facet joint pain has an intriguing history involving a diverse timeline of medical specialists. This paper aims to chart the pathway that led to its invention and the series of modifications and refinements that have led to modern practice. The story begins with the treatment of World War I soldiers by Nesfield, who used scalpels to cut “trapped” nerves. Inspired by Nesfield’s treatment, Rees developed the “percutaneous rhizolysis” technique in 1960. Shealy was the first to use radiofrequency electrodes for denervation of the facet joints, introducing his technique in 1971. Several radiofrequency electrode developments came about from collaborations with Cosman medical device entrepreneurs during the 1970s, including the Shealy Rhizolysis Kit, the Ray Rhizotomy Electrode, and the Sluijter-Mehta Kit. Subsequent dissections of Rees’ technique and modification of Shealy’s procedure by Bogduk saw the development of “percutaneous lumbar medial branch neurotomy” in 1980 by Bogduk and Long. Bogduk continued to contribute significantly to validation, refinement and acceptance of the technique. In 1998, the technique of pulsed radiofrequency was invented by Sluijter, Cosman, Rittman and van Kleef. Subsequent innovations have consisted of cooled radiofrequency neurotomy, multi-tined cannulae, endoscopic systems, and alternative denervation targets, such as the facet joint capsule. As we pass the first 100 years of the story, we believe there are more chapters to be written on this fascinating subject.

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

“…The technique of sensory branch ablation of the dorsal ramus to denervate the facet joint has significantly evolved with the improvements in pathophysiological understandings and surgical technology. In 1918, Vincent Nesfield described for the first time the denervation technique using an ophthalmic scalpel to directly cut the nerve [ 4 ]. The famous neurosurgeon Norman Shealy improved this technique with the use of fluoroscopy to target the medial branch of the facet joint.…”

Radiofrequency Ablation of Palmar Digital Branches of Ulnar Nerve in a Patient with Ulnar Neuropathy

“…Radiofrequency ablation (RFA) was developed for the treatment of chronic pain in the lumbar facet joints [10]. Using RFA is a minimally invasive and relatively safe way to symptomatically reduce nerve pain in the spinal areas [7].…”

Endoscopic Rhizotomy for Facetogenic Back Pain: A Review of the History, Financial Considerations, Patient Selection Criteria, and Clinical Outcomes

“…The technique of ER to ablate the sensory branches of the dorsal ramus has evolved with improvements in imaging, pathophysiological understanding, and surgical technology from the primitive description of events derived more than 100 years ago. According to Russo et al, 12 the first account of interventional rhizolysis for CBP was developed and performed by Vincent Nesfield in 1918. Nesfield believed that the cause was a sensory nerve "trapped" in muscle or tendon, a condition termed "trench back," alluding to the large number of soldiers from World War I who presented with unrelenting back pain.…”

“…13 In 1918, he developed a procedure using an ophthalmic scalpel that was inserted into the spine and propelled vertically to "cut" the trapped nerve. 12 Nesfield performed this procedure for more than 40 years, and in 1959, urologic surgeon William Rees became enamored of this work. 14 Rees began to specialize in treating CBP in rural Australia and later developed the multiple bilateral percutaneous rhizolysis procedure.…”