MRI for in vivo Analysis of Ablation Zones Formed by Cooled Radiofrequency Neurotomy to Treat Chronic Joint Pain Across Multiple Axial Spine Sites

Desai, Mehul; Safriel, Yair

doi:10.2147/jpr.s342795

Cited by 6 publications

(8 citation statements)

References 20 publications

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“…Although Bogduk et al have described the course of the medial branches in relation to the bony features of the lumbar vertebrae7 9 10 and the mamillo-accessory ligament (MAL),12 the anatomical relationship of the nerves to surrounding soft tissue remains to be further characterized. Soft tissue surrounding the medial branch may impede thermal coagulation/alter lesion size14 and is therefore an important anatomical consideration. Building on the foundational work by Bogduk et al , the objectives of this cadaveric study were to (1) investigate the course of the lumbar medial branches in relationship to bony and soft tissue landmarks and (2) discuss the anatomical implications for lumbar medial branch RFA.…”

Section: Introductionmentioning

confidence: 99%

Anatomical study of the medial branches of the lumbar dorsal rami: implications for image-guided intervention

Tran

Peng

Loh

2022

Reg Anesth Pain Med

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IntroductionFluoroscopic-guided radiofrequency ablation of the lumbar medial branches is commonly performed to manage chronic low back pain originating from the facet joints. A detailed understanding of the course of medial branches in relation to bony and soft tissue landmarks is paramount to optimizing lumbar denervation procedures, particularly parallel placement of the radiofrequency electrode. The objectives of this study were to investigate the relationship of medial branches to anatomical landmarks and discuss the implications for lumbar denervation.MethodsTen cadaveric specimens were meticulously dissected. The origin, course, and relationship of lumbar medial branches to bony and soft tissue landmarks were documented.ResultsThe medial branches followed the lateral neck of superior articular process deep to the intertransversarii mediales muscle at each lumbar vertebral level. In all specimens, the medial branches coursed laterally on the anterior half of the neck and transitioned from parasagittal-to-medial on the posterior half to reach the mamillo-accessory notch. The mamillo-accessory ligament was found to not occlude the nerve on the posterior quarter of the lateral neck but rather at the mamillo-accessory notch located at the posterior margin of the superior articular process.DiscussionA detailed understanding of the relationship of medial branches to anatomical landmarks is essential to optimizing needle placement for lumbar denervation procedures. The current study suggests that a parasagittal placement, with increased cranial-to-caudal angulation of the electrode, may improve parallel tip alignment with the targeted medial branch and represent a potential alternative to the traditional technique.

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Section: Introductionmentioning

confidence: 99%

Anatomical study of the medial branches of the lumbar dorsal rami: implications for image-guided intervention

Tran

Peng

Loh

2022

Reg Anesth Pain Med

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“…The diameter of the area can be 2 mm in unipolar, 6 mm in bipolar radiofrequency and between 8 and 10 mm in cooled radiofrequency ablation [21,22]. It was recently demonstrated on MRI that lesion size might be affected negatively by the proximity of the probes to bones, which can be an important factor in achieving better treatment results [23].…”

Section: Discussionmentioning

confidence: 99%

Cooled radiofrequency ablation of the sacroiliac joint a retrospective case series

Maalouly¹,

Rao²

2023

BMC Musculoskelet Disord

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Background Sacroiliac (SI) joint dysfunction is a common source of back pain. Recent evidence from different parts of the world suggest that cooled radiofrequency ablation of sacral nerves supplying the SI joints has superior pain alleviating properties than currently available treatment options for SI joint dysfunction. Patients and methods After obtaining institutional review board approval, the medical records of 81 patients who underwent cooled radiofrequency ablation in a single institution and by a single surgeon were analyzed retrospectively. The recurrence of pain, progression to fusion and functional outcomes were noted. The patients were operated on between June 2020 and December 2021, they include 59 females and 22 males, the average age was 55.4 ± 17.3. Follow up was at least 6 months postoperative. Results 22 of the patients had previously underwent lumbar fusions. Follow up period ranged from 6 to 18 months. After radiofrequency ablation, 7 patients progressed to fusions, and 6 patients had to have the procedure done again to relieve their pain. Student t-test was used to compare between preoperative and postoperative values of NPRS (numerical pain rating score) and ODI (Oswestry disability index). It showed significance with P-value < 0.001 in both. Conclusions Sacroiliac joint radiofrequency ablation is a good option in the treatment of SI joint pain showing good results in the short term follow up period. It is a simple procedure that can be done in less than 30 min and is capable of providing significant pain relief for patients with sacroiliac joint dysfunction.

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“…It is important to also consider that many in vivo factors including surrounding tissues, striations in musculature, and probe placement in very close proximity to bone all impact ablation zone size and shape, which can result in irregular ablation patterns. 19,32 When the RF probe is placed directly against bone, which acts as an insulator due to its higher electrical impedance, 19 the lesion is projected outward perpendicular to the needle axis in the vertical plane. 32 Desai et al noted in their MRI in vivo analysis of cooled RF ablation zones that the majority of ablation zones with irregular or atypical borders appeared to be impacted by the probe's proximity to bone.…”

Section: Conc Lusionmentioning

confidence: 99%

“…In fact, enhancing the tip diameter, tip length, tip temperature, and/or lesion time increases the size and length of a confluent lesion. Desai and Safriel 19 performed the first in vivo magnetic resonance imaging study on patients following cooled radiofrequency. The authors noted several factors that affected lesion size and geometry including proximity to bone, connective tissue, and striations within muscle tissue adjacent to the RFA probe 19 .…”

Section: Introductionmentioning

confidence: 99%

“…Desai and Safriel 19 performed the first in vivo magnetic resonance imaging study on patients following cooled radiofrequency. The authors noted several factors that affected lesion size and geometry including proximity to bone, connective tissue, and striations within muscle tissue adjacent to the RFA probe 19 . Despite the host of basic science work, there have been no recommendations for the various bipolar probe gauges and their respective interprobe distances (IPD) with the goal of maintaining a confluent lesion in the literature thus far.…”

Section: Introductionmentioning

confidence: 99%

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Bipolar radiofrequency ablation lesion areas and confluence: An ex vivo study and technical report

Wondra,

Gulhar,

Brestle

et al. 2023

Pain Practice

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IntroductionRadiofrequency ablation (RFA) has been used for nearly 100 years, treating an array of medical conditions including chronic pain. Radiofrequency (RF) energy depolarizes and repolarizes tissues adjacent to a probe producing heat and causing direct thermal injury. When positioned adjacent to neural structures, it leads to neural tissue injury and cell death interrupting pain signaling with the ultimate goal of providing lasting pain relief. Today, RFA is commonly used to treat cervical, thoracic, and lumbar zygapophyseal joints, sacroiliac joint, and more recently large peripheral joint‐mediated pain. There are several applications of RFA systems, including bipolar, conventional thermal, cooled, protruding, and pulsed. As yet, no study has determined the best technical practice for bipolar RFA.ObjectiveThis ex vivo study examines RFA lesion midpoint (LMP) area and lesion confluence comparing three different commonly used gauge (g) probes (18‐g, 20‐g, and 22‐g) with 10‐mm active tips at various interprobe distances (IPD) to guide best technical practices for its clinical application.MethodsBipolar RFA lesions were generated in preservative‐free chicken breast specimens using three different gauge probes (18‐g, 20‐g, and 22‐g) with 10‐mm active tips at various IPD (6, 8, 10, 12, 14, 16, and 18 mm). RF was applied for 105 s (15‐s ramp time) at 80°C for each lesion at both room and human physiological temperature. The specimen tissues were dissected through the lesion to obtain a length, width, and depth, which were used to calculate the LMP area (mm2). The LMP areas of each thermal ablation were investigated using visualization and descriptive analysis. The Kruskal–Wallis test was performed to compare LMP areas between the two temperature groups and the three different gauge probe subgroups at the various IPDs.ResultsOf the 36 RF lesions (14: 18‐g, 12: 20‐g, and 10: 22‐g) performed, 24 demonstrated lesion confluence. The average time to reach 80°C was 16–17 s; therefore, the average time of RF‐energy delivery (at goal temperature) was 88–89 s despite varying needle size or IPD. Comparing the 25 and 37°C groups, 18‐g probes produced mean LMP areas of 73.7 and 79.2 mm2, respectively; 20‐g probes produced mean LMP areas of 66 and 66.8 mm2, respectively; 22‐g probes produced mean LMP areas of 56.6 and 59.7 mm2, respectively. There was no statistical evidence to state a difference regarding LMP area between temperature groups; however, the 18‐g probes produced consistently larger LMP areas in the 37°C compared to 25°C specimen groups at each IPD. Lesion confluence was lost for 18‐g, 20‐g, and 22‐g probes at IPD of 14, 12, and 10 mm, respectively, in both 25 and 37°C groups. LMP area was similar between 6 and 8 mm IPD in all of the three‐gauge groups; however, there was a significant drop in LMP area from 8 mm IPD to 10 mm and greater. The 18‐g, 20‐g, and 22‐g probes all demonstrated a sharp decline in LMP area when increasing the IPD from 8 to 10 mm.ConclusionThis ex vivo technical study evaluated bipolar RFA LMP areas and lesion confluence, and determined the recommended IPD of 18‐g, 20‐g, and 22‐g probes to be less than 12, 10, and 8 mm, respectively, for best clinical practice. Placing bipolar probes at an IPD greater than 14, 12, and 10 mm, respectively, risks the loss of lesion confluence and failure to produce a clinically significant treatment response due to lack of nerve capture. In clinical practice, the use of injectate may produce larger lesions than demonstrated in this study. Additionally, in vivo factors may impact ablation zone size and ablation patterns. As there are a paucity of studies comparing various RFA applications and conventional RFA needles are least expensive, it is possible that bipolar conventional RFA is more cost‐effective than other techniques.

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MRI for in vivo Analysis of Ablation Zones Formed by Cooled Radiofrequency Neurotomy to Treat Chronic Joint Pain Across Multiple Axial Spine Sites

Cited by 6 publications

References 20 publications

Anatomical study of the medial branches of the lumbar dorsal rami: implications for image-guided intervention

Anatomical study of the medial branches of the lumbar dorsal rami: implications for image-guided intervention

Cooled radiofrequency ablation of the sacroiliac joint a retrospective case series

Bipolar radiofrequency ablation lesion areas and confluence: An ex vivo study and technical report

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