Cervical facet radiofrequency neurotomy

More than 50% of posttraumatic cervical pain after events such as whiplash is caused by facet joint injury. These patients present with neck pain that often radiates to the head or shoulders and is aggravated by neck movement. Imaging studies are usually negative. If diagnostic local anesthetic blocks of the facet nerves produce appropriate pain relief, then significant and long-lasting pain relief may be obtained by percutaneous cervical facet radiofrequency neurotomy. This outpatient procedure is performed by using fluoroscopy and strictly adhering to proper needle placement. Stimulation is performed before radiofrequency neurotomy to avoid sensory or motor deficits; however, temporary cutaneous dysesthesia and numbness are not uncommon. Success rates range from 60% to 70% with a duration of months to years. The procedure can be repeated if necessary. In addition to pain relief, activities of daily living can be restored, rehabilitation facilitated, and resolution of associated psychological distress can occur. Copyright © 2000 by W.B. Saunders Company     

Factors predicting success and failure for cervical facet radiofrequency denervation: a multi-center analysis

BACKGROUND AND OBJECTIVES: The concept of radiofrequency denervation has recently come under question in light of several studies showing minimal to no benefit. One possibility proposed for these negative outcomes is poor selection criteria. Unlike virtually all other spine interventions, the factors associated with success and failure for cervical facet denervation have yet to be determined. The purpose of this study is to determine which demographic, clinical and treatment factors are associated with cervical facet radiofrequency denervation outcomes. METHODS: Data were garnered from 3 academic medical centers on 92 patients with chronic neck pain who underwent radiofrequency denervation after a positive response to diagnostic local anesthetic blocks. Success was defined as at least 50% pain relief lasting at least 6 months. Variables evaluated for their association with outcome included age, sex, duration of pain, opioid use, pain referral pattern, paraspinal tenderness, pain exacerbated by extension/rotation, magnetic resonance image abnormalities, diabetes, smoking, scoliosis, obesity, prior surgery, and levels treated. RESULTS: The only clinical variable associated with success was paraspinal tenderness. Factors associated with treatment failure included radiation to the head, opioid use, and pain exacerbated by neck extension and/or rotation. CONCLUSIONS: Selecting patients based on key clinical variables may increase the chance of treatment success for cervical facet radiofrequency denervation.     

The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials

Background Context

Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial.

尺神经深支卡压的解剖学及临床意义

目的：探讨尺神经深支卡压的病因及诊治方法：方法：显微镜下观测３０例成人手的尺神经深支。封闭及手术治疗９例患者。结果：尺神经深支分４段。封闭（４例）和手术（７例０各治愈同１例、５例。结论：腕尺管段尺神经深支最易受损,在其它部位也会被止准确无误。本病应尽早手术。     

Cervical facet joint kinematics during bilateral facet dislocation

Previous biomechanical models of cervical bilateral facet dislocation (BFD) are limited to quasi-static loading or manual ligament transection. The goal of the present study was to determine the facet joint kinematics during high-speed BFD. Dislocation was simulated using ten cervical functional spinal units with muscle force replication by frontal impact of the lower vertebra, tilted posteriorly by 42.5°. Average peak rotations and anterior sliding (displacement of upper articulating facet surface along the lower), separation and compression (displacement of upper facet away from and towards the lower), and lateral shear were determined at the anterior and posterior edges of the right and left facets and statistically compared (P < 0.05). First, peak facet separation occurred, and was significantly greater at the left posterior facet edge, as compared to the anterior edges. Next, peak flexion rotation and anterior facet sliding occurred, followed by peak facet compression. The highest average facet translation peaks were 22.0 mm for anterior sliding, 7.9 mm for separation, 9.9 mm for compression and 3.6 mm for lateral shear. The highest average rotation of 63° occurred in flexion, significantly greater than all other directions. These events occurred, on average, within 0.29 s following impact. During BFD, the main sagittal motions included facet separation, flexion rotation, anterior sliding, followed by compression, however, non-sagittal motions also existed. These motions indicated that unilateral dislocation may precede bilateral dislocation.     

A review of current concepts in radiofrequency chondroplasty

Radiofrequency (RF) chondroplasty is a promising treatment of chondral defects. The purpose of this study is to summarize current literature reporting the use of radiofrequency energy as an alternative treatment to mechanical shaving in chondroplasty. This review depicts the basic understanding of RF energy in ablating cartilage while exploring the basic science, laboratory evidence and clinical effectiveness of this form of chondroplasty. Laboratory studies have indicated that RF energy decreases inflammatory markers in the cartilage as well as providing optimal results with smoothing of chondral clefts. There have been concerns of chondrolysis due to heat damage of chondrocytes; however, this is unsubstantiated in clinical studies. These clinical trials have highlighted that RF energy is a safe and efficacious method of chondroplasty when compared to the mechanical shaving technique.     

Radiographic changes induced after cervical facet radiofrequency denervation

BACKGROUND CONTEXT: Paraspinal infections after zygapophyseal (facet) radiofrequency denervation (RFD) are a serious but rare complication of this procedure. We are aware of only one case report of an epidural abscess after facet joint injection. PURPOSE: To report post-procedure inflammatory changes after cervical facet RFD. STUDY DESIGN: Case report. PATIENT SAMPLE: A 35-year-old Caucasian female. METHODS: Retrospective case review. RESULTS: The patient underwent cervical RFD and was admitted to the hospital 7 days after her procedure with severe neck pain. Magnetic resonance imaging (MRI) with contrast revealed what appeared to be evidence of a paraspinal muscle abscess although blood tests were negative. She was treated with antibiotic therapy, yet she never developed systemic signs of infection. A follow-up MRI without contrast revealed no evidence of infection, and she was discharged home on hospital day 6. At her first follow-up visit, she was still experiencing scalp pain and paraspinal muscle spasm. During subsequent follow-up visits, she has continued to improve clinically without experiencing signs of infection. Another follow-up MRI 6 weeks after her discharge home revealed persistent minimal left paraspinal enhancement at C2-3, possibly representing post-procedure granulation tissue with no evidence of abscess. CONCLUSIONS: Post-procedural MRI findings after radiofrequency lesioning can resemble radiographic findings associated with a paraspinal abscess. Patients with radiographic findings consistent with abscess should only be treated if clinical signs or symptoms of systemic infection are present.     

Percutaneous facet denervation in chronic thoracic spinal pain

Summary In 40 patients with chronic thoracic spinal pain of more than 12 months duration which failed to respond to conservative treatment and with a previous evaluation by specialists, mainly neurologists and orthopaedic surgeons, the diagnosis of facet syndrome was made. This diagnosis was based on clinical criteria and a transient positive response to a prognostic blockade of the medial branch of the dorsal ramus of the thoracic spinal nerve. They were selected to undergo percutaneous radiofrequency denervation of the facet joints. The short and long-term results of 51 percutaneous thoracic facet denervations in 40 patients are described. After 2 months, 19 patients (47.5%) were pain-free, 14 patients (35%) had more than 50% pain-relief, and 7 patients (17.5%) had no relief. After a follow-up of 18–54 (average 31) months in 36 cases (3 patients had died because of malignancy, and 1 had undergone a spinal fusion), 16 patients (44%) were pain-free, 14 patients (39%) had more than 50% pain-relief and in 6 cases (17%) the result was poor. Adverse effects consisted of postoperative pain in 5 patients (12.5%). When conservative treatment fails, percutaneous thoracic facet denervation can be a safe and beneficial therapy in chronic thoracic spinal pain originating from the facet joints.     

射频治疗面部寻常性痤疮

目的:观察射频治疗面部寻常性痤疮的疗效。方法:应用射频治疗仪治疗20例面部寻常性痤疮患者,病情Ⅱ～Ⅳ级,治疗能量20～330J,每周2次,连续治疗4周,每次治疗前观察记录临床反应并拍摄皮损照片。结果:20例患者,治疗4周后观察,总有效率80%,治疗期间未发现任何不良反应。结论:非侵入性射频治疗是一种可选择用于治疗中重度寻常性痤疮安全、有效的方法。     

Percutaneous radiofrequency facet denervation in low-back and extremity pain

Summary The present series includes 47 patients (35 females 12 males) with an average observation time of 8 months after percutaneous lumbar facet denervation by radiofrequency electrocoagulation. All patients had static and kinetic lumbar pain; 90% of them had pain radiating into the legs. None had clinical or radiologic (radiculography and/or CT scan) evidence of a lumbar disc herniation, and all had exhausted conservative therapy. All but one had provocation of their habitual pain on arthrography of the relevant intervertebral lumbar joints and/or on intraoperative stimulation prior to electrocoagulation. 22/47 of the patients had no immediate or late beneficial effect of the electrocoagulation. Eight of the remaining 25 patients had satisfactory relief of pain at follow-up. The failures included all patients with previous multiple lumbar operations except for three.Part of this read as paper at the 35th Annual Meeting of the Scandinavian Neurosurgical Society, June 1–4, 1983, Helsinki, Finland.     

腓肠神经内侧头肌支切断术瘦小腿

目的探讨一种以腓肠神经内侧头肌支切断来改善小腿外形的新方法。方法在腘窝处切开,暴露腓肠神经内侧头肌支,并切断,使局部肌肉失神经萎缩,而缩小小腿的容积。结果本组4例,术后小腿周径平均缩小3.6±0.8cm,小腿外形满意。结论本方法为一简单、安全而有效的技术,能达到缩小小腿部的目的。     

射频消融治疗肝脏肿瘤的临床研究

目的探讨运用冷循环射频消融技术治疗肝脏肿瘤的效果及其临床应用价值。方法应用美国RF2000型冷循环射频治疗仪,在局部麻醉或静脉麻醉下将电极针经皮穿刺入瘤体内损毁肿瘤组织,或在开腹直视下行肝穿刺进入缩体损毁肿瘤组织。对于肿瘤直径较大(>8 cm)或是肿瘤数量较多(>3个)的患者采用射频治疗和超声聚焦刀、肝动脉栓塞化疗联合的方式进行治疗。用上述方法对2001年11月～2006年6月的347例肝脏肿瘤患者进行了治疗。结果347例病人中肿瘤单发直径小于或等于3cm者24例,肿瘤完全性毁损。肿瘤单发直径大于3cm小于8cm者89例部分肿瘤完全性损毁。肿瘤多发或单发直径大于8 cm者234例,经多点多次联合治疗后仍有肿瘤残余。治疗前甲胎蛋白(alpha,fetop rotcin,AFP)大于或等于400μg/L者261例。术后复查,大部分患者AFP出现不同程度下降。治疗后CT显示治疗区域肿瘤缩小液化坏死或强化减弱。结论冷循环射频消融是一种创伤小、容易耐受、时间短、安全方便的治疗肝脏肿瘤确实有效的方法。     

Pulsed radiofrequency for the treatment of chronic ilioinguinal neuropathy

Background Ilioinguinal neuropathy is a rare but disabling condition. The condition may arise spontaneously or in the setting of pelvic surgery. To date, most therapeutic options have been limited to neuropathic pain medications, anti-inflammatory medications, nerve blocks with local anesthetics, or neurectomy. Long-term results of non-surgical interventions are fair at best. We present a case of chronic ilioinguinal neuropathy treated with pulsed radiofrequency. Objective To examine the efficacy of pulsed radiofrequency (PRF) lesioning on pain in ilioinguinal neuropathy. Method A 58-year old man with chronic ilioinguinal neuropathy was treated with PRF and was followed for 3 months. Results The patient had significant pain relief at 3 months follow up. Conclusion Pulsed radiofrequency lesioning may be a good treatment for chronic ilioinguinal neuropathy in cases refractory to conservative management.     

Role of radiofrequency ablation for liver malignancies

Radiofrequency ablation (RFA) is commonly used to treat unresectable malignant liver tumours. It can achieve effective local tumour control and the maximal normal liver parenchyma can be preserved. In recent years, there has been a tremendous expansion in the application of RFA for patients with malignant liver tumours. However, the therapeutic effect of this local ablation treatment needs to be balanced against its risks and possible local failure. The present review focuses on the role of RFA for liver malignancies, with special attention to the indication, approaches, complications, survival benefits, combination therapies and comparison with other treatment modalities. Despite favourable results of most clinical studies of RFA, the associated risks and tumour recurrence of this treatment modality should not be underestimated. Careful patient selection, meticulous RFA techniques, and prompt treatment of residual and recurrent tumours are necessary to ensure a better outcome after RFA. Until recently, there has been no strong evidence showing that RFA can replace any other treatment modalities in the management of liver tumours. Nonetheless, more convincing evidence by randomized trials is required for the establishment of a treatment protocol of RFA for patients with liver malignancies.     

Haemostatic partial nephrectomy using bipolar radiofrequency ablation

OBJECTIVE: To determine whether an electrode array with a bipolar radiofrequency ablation (RFA) energy source can be used to perform a haemostatic partial nephrectomy by simultaneously ablating and coagulating renal tissue. MATERIALS AND METHODS: Lower-pole partial nephrectomy was performed in 12 porcine kidneys using a bipolar RFA system. Intraoperative ultrasonography was used to identify and avoid the collecting system. Tissues were positioned between opposing electrodes and tissue impedance monitored using a proprietary feedback and control algorithm. Ablation time and power, lesion width and length, and tissue thickness were recorded. The kidneys were assessed in vivo to show haemostasis of the remaining renal unit. Collecting system integrity was assessed with methylene blue injection, and the resected tissue analysed histologically. RESULTS: Partial nephrectomies were successful in all 12 porcine kidneys; the mean nephrectomy specimen was 3.2 x 2.6 cm. The total ablation time (sem) per lesion was 211 (15) s and the mean power was 23 W. Methylene blue injection showed an intact collecting system in 11 of the 12 kidneys, and haematoxylin and eosin staining showed a mean zone of necrosis of 9 mm at the resection margin. Ultrasonography revealed flow to the remaining kidneys after RFA and the in vivo assessment of haemostasis revealed no abnormal bleeding or haemorrhage from the kidneys. CONCLUSIONS: Applying bipolar RF energy to an electrode array can enable transmural excision of renal parenchyma in vivo in a bloodless fashion without collecting system injury.     

Arthroscopic triangular fibrocartilage complex debridement using radiofrequency probes

The initial results of using radiofrequency probes for debridement of a torn triangular fibrocartilage complex were studied in 20 patients with a mean age of 44 (range 27-56) years presenting with ulnar-sided wrist pain. On arthroscopic examination, 18 central and two radial triangular fibrocartilage complex tears were identified and debrided to a stable rim using radiofrequency probes. The mean follow-up was 22 (range 9-35) months. Seventeen patients experienced substantial pain relief. In three, the pain was unchanged. The mean flexion extension arc was 132 degrees , pronosupination arc 155 degrees and mean grip strength was 83% of that of the unaffected side. Using the modified Mayo wrist score, there were ten excellent, seven good and three fair results. No perioperative complications occurred. Radiofrequency probes were found to be safe and effective for use in triangular fibrocartilage complex debridement. These results compare favourably with other standard methods of treatment of this problem.