Cooled Versus Conventional Thermal Radiofrequency Neurotomy for the Treatment of Lumbar Facet–Mediated Pain

Bajaj, Prempreet; Napolitano, Jonathan; Wang, Wenbao; Cheng, Jianguo; Singh, Jaspal

doi:10.1016/j.pmrj.2015.09.001

Cited by 6 publications

(7 citation statements)

References 36 publications

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“…This advantage makes cooled radiofrequency a better choice of treatment at particular targets with anatomically high variations of nerve distribution, such as the thoracic facet joint and sacroiliac joint. Usually, this technique is safe and short, and can reduce radiation exposure theoretically (15). However, the risk of burn injury was reported (16), and there is still lack of large and long-term randomized-controlled studies to prove its cost-effectiveness.…”

Section: Bogduk Et Al (7) Postulated a Biomechani-mentioning

confidence: 99%

A Modified Pain Therapy for Thoracic Compression Fracture in the Elderly: Cooled Radiofrequency Ablat ion at Thoracic Facet Joints

Md¹

2019

PMCR

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We reported an alternative therapy for 2 cases respectively with acute and old thoracic compression fracture and persistent back pain. A 94-yearold woman who had multiple comorbidities suffered from severe pain that was caused by an acute thoracic spine compression fracture. The other patient was an 89-year-old man with an old thoracic compression fracture for 2 years. Neither of them could have satisfactory pain relief by the conservative treatments. Surgical intervention was also not considered. Cooled radiofrequency ablation was applied to both patients’ thoracic facet joints. The 2 patients’ back pain improved considerably after the ablation. Cooled radiofrequency ablation over thoracic facet joints could be a pain management alternative for relieving thoracic compression fracture-related pain. Key words: Compression fracture, thoracic vertebra, cooled radiofrequency denervation, facet joint, comorbidity

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Section: Bogduk Et Al (7) Postulated a Biomechani-mentioning

confidence: 99%

A Modified Pain Therapy for Thoracic Compression Fracture in the Elderly: Cooled Radiofrequency Ablat ion at Thoracic Facet Joints

Md¹

2019

PMCR

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“…[6] However, application of TRFA technique may be technically limited by the presence of anatomical variations in certain patient populations such as in patients with scoliotic deformity, severe degenerative changes, facet arthropathy, and bone spurs. [7] The placement of electrodes parallel to medial branches as described in the TRFA technique may not be technically straightforward or possible secondary to distorted anatomy in such patients. The technique for CRFA does not necessarily require placement of electrodes parallel to medial branches as the ablative area extends distally from the tip of the electrode.…”

Section: Introductionmentioning

confidence: 99%

“…Application of proper technique for TRFA is described by Spinal Intervention Society Guidelines [6] . However, application of TRFA technique may be technically limited by the presence of anatomical variations in certain patient populations such as in patients with scoliotic deformity, severe degenerative changes, facet arthropathy, and bone spurs [7] . The placement of electrodes parallel to medial branches as described in the TRFA technique may not be technically straightforward or possible secondary to distorted anatomy in such patients.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the placement of the CRFA electrodes perpendicular to medial branches, similarly to the placement of needles for application of diagnostic medial branch blocks described in the literature, [1] would theoretically suffice to ablate the targeted medial branches. Therefore, CRFA could potentially reduce the overall radiation exposure since having easier access to the nerves enables the use of shorter fluoroscopy times to obtain optimal imaging to help with the needle placement [7] . In spite of these anticipated advantages of large ablative area with CRFA, there is also a low level of certainty that larger lesions increase the chance of capturing nerves and increase the duration of pain relief [3] …”

Section: Introductionmentioning

confidence: 99%

“…Therefore, CRFA could potentially reduce the overall radiation exposure since having easier access to the nerves enables the use of shorter fluoroscopy times to obtain optimal imaging to help with the needle placement. [7] In spite of these anticipated advantages of large ablative area with CRFA, there is also a low level of certainty that larger lesions increase the chance of capturing nerves and increase the duration of pain relief. [3] There is limited literature support for the use of CRFA as a treatment option for facet joint mediated pain.…”

Section: Introductionmentioning

confidence: 99%

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Cooled-radiofrequency neurotomy for the treatment of chronic lumbar facet (zygapophyseal) joint pain

Candan

Güngör

2021

Medicine

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Cooled-radiofrequency (CRFA) is a newer technique and may have some theoretical advantages over traditional radiofrequency ablation (TRFA). In this study, we aimed to investigate the efficacy and safety of CRFA for the treatment of lumbar facet joint-mediated pain. In this retrospective study, we evaluated 185 CRFA performed on 105 patients. All patients with axial lower back who received the preliminary diagnosis of lumbar facet joint-mediated pain and refractory to conservative therapy underwent diagnostic medial branch blocks. CRFA was recommended to those patients who responded favorably to two sets of diagnostic medial branch blocks. Pain scores in numeric rating scale (NRS) were recorded pre-treatment and post-treatment at different time-points. The primary outcome measure was to report descriptive NRS score and average % improvement from baseline at each time point. A significant pain relief was determined by a decrease of ≥50% of mean NRS. Secondary outcome measure was the time to repeat treatment with subsequent CRFA. Adverse events were also recorded. Primary outcome measure determined as the improvement in NRS, for at least 50% or more, was achieved in both 1st (4–8 weeks) and 2nd (>2–6 months) follow-up (FU) with 60.5% and 53.6% reduction in NRS respectively. Our subgroup analysis comparing the younger (<50) and older (≥50) age groups showed superior pain relief with CRFA in the older (≥50) age group, both in the 1st (4–8 weeks) and 2nd (>2–6 months) FU time points (63.4% and 58.4% reduction in NRS, respectively). Cooled-radiofrequency ablation is an effective and safe procedure for the treatment of chronic lumbar facet joint related pain. The duration of pain relief was comparable to traditional radiofrequency ablation as reported in the literature.

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History and Development of Radiofrequency Ablation for Chronic Pain

Hagedorn

Golovac

Deer

et al. 2021

Essentials of Radiofrequency Ablation of the Spine and Joints

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Cooled Versus Conventional Thermal Radiofrequency Neurotomy for the Treatment of Lumbar Facet–Mediated Pain

Cited by 6 publications

References 36 publications

A Modified Pain Therapy for Thoracic Compression Fracture in the Elderly: Cooled Radiofrequency Ablat ion at Thoracic Facet Joints

A Modified Pain Therapy for Thoracic Compression Fracture in the Elderly: Cooled Radiofrequency Ablat ion at Thoracic Facet Joints

Cooled-radiofrequency neurotomy for the treatment of chronic lumbar facet (zygapophyseal) joint pain

History and Development of Radiofrequency Ablation for Chronic Pain

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