Percutaneous Radiofrequency Facet Rhizotomy – Experience with 118 Procedures and Reappraisal of its Value

Tzaan, Wen-Ching; Tasker, Ronald R.

doi:10.1017/s0317167100052227

Cited by 85 publications

(56 citation statements)

References 34 publications

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“…Radiofrequency at set temperatures of 45°C demonstrated pathological lesions in nerve fibers [2]. Cooled-radiofrequency electrodes have been described for heating large tissue volumes [3]. Increased lesion diameter may improve the likelihood of successful nerve ablation.…”

Section: Discussionmentioning

confidence: 99%

International Spine Intervention Society Annual Meeting Abstracts

2009

Pain Med

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Introduction: Intradiscal biacuplasty is an innovative treatment for lumbar discogenic pain. Two electrodes, inserted into the posterolateral corners of the disc, produce a three-dimensional heat lesion across the posterior anulus, which purportedly seals radial and circumferential fissures, and coagulates nerve endings throughout the posterior anulus. Methods: As part of a multi-centre study, a prospective audit of outcomes was undertaken in 14 patients with chronic low back pain due to internal disc disruption. All patients completed clinical assessments before treatment and at one, two, three, six, and 12 months after treatment, using a visual analogue scale for pain, and the SF36 for disability and function. Results: At inception, the median scores (interquartile range) for the sample were 65 (45-75) for pain, 30 (24-51) for physical functioning, and 50 (25-50) for social functioning. The treatment was easy to execute. Heating the disc was totally painless. No patient suffered any complications or side-effects. After treatment, seven patients reported no benefit; three had benefit at one month, but their pain scores deteriorated by three or six months. Four patients (28%) reported benefit, with reduction in pain by 60% in two, 80% in one, and 100% in the fourth, sustained for 12 months, corroborated by improvements in physical and activities of daily living, and reduction of medication to occasional simple analgesics. Discussion: Although biacuplasty has only a limited success rate, the one in four patients who benefitted were very satisfied with their outcomes. To distinguish the small success rate from a placebo effect would require a very large trial. Remarkable is how simple and innocuous the treatment is. Improvements in the technology of the procedure, such as curved electrodes and better temperature settings, might provide better coverage of the painful segment of the target disc, and thereby increase the success rate. Background: A self-reported questionnaire that simultaneously measures domains of pain and disability, is reliable, valid, responsive, quick to administer and easy to understand would be a useful spine care tool. Purpose: To evaluate the reliability, validity, responsiveness and ease-of-use of a short composite low back paindisability questionnaire (PDQ-S). Method: 73 subjects undergoing spinal intervention procedures (injection or neurotomy) completed 3 questionnaires: McGill pain, Oswestry disability and PDQ-S twice prior to their procedure (1 month apart) and once following (2 weeks post injection; 6-8 weeks post neurotomy). The PDQ-S is a 4 question (pain intensity and frequency; 2 patient specific disabilities) VAS scored questionnaire. Analysis: a. Test-retest reliability: repeated measures ANOVA and Pearson's correlation coefficient; b. Validity: Pearson's correlation of the pain question scores of the PDQ-S with the McGill, and the disability questions scores of the PDQ-S with the Oswestry; c. Responsiveness: Responsiveness Index (RI) scores; d. Practicality: average time to comp...

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Section: Discussionmentioning

confidence: 99%

International Spine Intervention Society Annual Meeting Abstracts

2009

Pain Med

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“…More recently, Shealy suggested that RF denervation be [10][11][12][13][14][15][16][17][18][19][20]. The authors of the most recent studies have reported success rates ranging widely between 32 and 87% [5][19] [21].…”

Section: Discussionmentioning

confidence: 99%

“…This result is comparable with that achieved in patients without a history of spine surgery. Another possible explanation for reported variations is the involvement of health insurance and worker's compensation issues [7][19] [21].…”

Section: Discussionmentioning

confidence: 99%

Alternative denervation using laser irradiation in lumbar facet syndrome

2007

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“…Percutaneous radiofrequency lumbar facet denervation was introduced as a treatment for chronic low back pain by Shealy in 1974 [1,3]. Kornick et al [2], however, reported that X-ray fluoroscopy-guided percutaneous radiofrequency denervation of lumbar facets is associated with an overall 1.0% incidence of complications.…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous radiofrequency rhizotomy of the medial branch of the posterior rami is used to treat chronic low back pain [1][2][3]. X-ray fluoroscopy-guided percutaneous rhizotomy has been used for spinal pain management for many years.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous radiofrequency lumbar facet rhizotomy guided by computed tomography fluoroscopy

et al. 2005

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X-ray fluoroscopy-guided percutaneous radiofrequency facet rhizotomy is used to treat chronic low back pain. The traditional fluoroscopic approach to the medial branch of the posterior rami, however, is associated with a small incidence of complications. We describe a new method for radiofrequency lumbar facet rhizotomy in which computed tomography (CT) fluoroscopy is used to guide needle placement. Three patients with chronic intractable low back pain underwent CT fluoroscopy-guided percutaneous facet rhizotomy. After the safest and shortest route to the target site was determined on the CT image, the needle was advanced along the predetermined route under real-time CT fluoroscopy. When the needle tip was located at the target site, electrical stimulation was applied to verify proper electrode placement. After confirming the clinical effect and lack of complications under test block with a local anesthetic, denervation was performed using radiofrequency current. Pain scores of all patients were reduced after the procedure without any complications such as paralysis or neuritic pain. None of the patients complained of severe discomfort during the procedure. CT fluoroscopy-guided percutaneous lumbar facet rhizotomy appears to be safe, fast, and effective for patients with lumbar facet pain.

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Percutaneous Radiofrequency Facet Rhizotomy – Experience with 118 Procedures and Reappraisal of its Value

Cited by 85 publications

References 34 publications

International Spine Intervention Society Annual Meeting Abstracts

International Spine Intervention Society Annual Meeting Abstracts

Alternative denervation using laser irradiation in lumbar facet syndrome

Percutaneous radiofrequency lumbar facet rhizotomy guided by computed tomography fluoroscopy

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