Safety of Lumbar Spine Radiofrequency Procedures in the Presence of Posterior Pedicle Screws: Technical Report of a Cadaver Study

Gazelka, Halena M.; Welch, Tasha L.; Nassr, Ahmad; Lamer, Tim J.

doi:10.1111/pme.12678

Cited by 13 publications

(19 citation statements)

References 6 publications

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“…With the increase in spinal instrumentation surgery interventional spine practitioners are likely to encounter patients with symptomatic zygapophysial joint pain [6]. However, hazards to the safe conduct of RFN arise in patients in whom pedicle screws have been used to facilitate fusion.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Lumbar Spine Radiofrequency Neurotomy in the Presence of Posterior Pedicle Screws.

Klessinger¹

2016

Prog Orthop Sci

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Objective: To determine the safety and the efficacy of lumbar spine radiofrequency neurotomy performed in the presence of pedicle screws in patients with chronic low back pain. Methos: Retrospective practice audit. Review of charts of all patients who underwent lumbar radiofrequency neurotomy in the presence of pedicle screws. Patients were tested with a minimum of two controlled medial branch blocks and treated with radiofrequency neurotomy. A successful outcome was defined as at least 50% pain reduction for a minimum of three month. Results: Thirty eight patients were identified with pedicle screws present at the time of the neurotomy. No adverse effects were observed and no patients reported a worsening of the pain after RFN. No clinical effect related from heating of the metal devices was observed. A pain reduction of at least 50% for a minimum of three months was achieved in 20 patients (52.6%). Pain in the index segments and also in adjacent segments was treated with no difference in success. Conclusion: Some 50% of the patients with pedicle screws benefits from radiofrequency neurotomy for about six months. This potential benefit for the patient must be offset against the risk of the procedure, which might be higher because of the increase in temperature of the metal devices. Still, no adverse effects were observed. Selection of treatment level and positioning the electrode next to the pedicle screws are challenging.

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Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Lumbar Spine Radiofrequency Neurotomy in the Presence of Posterior Pedicle Screws.

Klessinger¹

2016

Prog Orthop Sci

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“…One proposed risk of performing an RFN procedure in patients with posterior spinal instrumentation is the transmission of heat through the metallic hardware, causing thermal injury to surrounding structures. A cadaver study showed that it is possible for pedicle screws to heat significantly when in direct contact with an RF cannula (10). Additionally, a prospective study showed pedicle screws are capable of temperature increases (11).…”

Section: Methodsmentioning

confidence: 99%

“…Outcome measures were selected from potential serious complications/adverse events suggested in recently published papers (10,11). Chart abstraction criteria were developed by the research team based on these outcome measures (Table 1).…”

Section: E479mentioning

confidence: 99%

“…A recent cadaver study showed that direct contact between an RF cannula and a pedicle screw, heated to 80°C for 90 seconds, produced substantial temperature changes throughout the length of the screw (mean range: 4.4°C -16.72°C above baseline temperature) (10). However, when the RF cannula was placed at the conventional RF cannula target position (the junction of the transverse process and the superior articular process) and not in direct contact with the pedicle screw, these dramatic increases in the temperature of the pedicle screw did not occur (mean range: 0.32°C -1.84°C above baseline temperature) (10). Therefore, a clinically meaningful increase in pedicle screw temperature seems to be largely dependent on whether the RF probe is in direct contact with the screw.…”

Section: E481 Spinal Radiofrequency Neurotomy In Patients With Metallmentioning

confidence: 99%

“…in the literature of RFN-related adverse events directly attributable to the heating of metallic instrumentation (10,11). A retrospective study evaluating the safety and efficacy of RFN procedures in the presence of lumbar posterior pedicle screws reported no adverse events or worsening pain (12).…”

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confidence: 99%

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A Retrospective Review of Spinal Radiofrequency Neurotomy Procedures in Patients with Metallic Posterior Spinal Instrumentation – Is it Safe?

2018

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Background: Recent studies have shown that medial branch radiofrequency neurotomy (RFN) procedures done at the level of a pedicle screw can increase pedicle screw temperature, and it has been speculated that pedicle screw heating may cause thermal injury. There has been a limited amount of investigation into the real-world safety profile of RFN procedures in patients with pedicle screws. Objectives: We aim to demonstrate that the occurrence of serious adverse events is rare for a medial branch RFN procedure completed at a level with metallic spinal hardware when performed according to the Spine Intervention Society practice standards. Study Design: This study involved retrospective chart reviews of every patient who received an RFN procedure for spinal facet joint pain during the 5-year time period from 2012-2016. Setting: The research took place within a single university-based interventional pain management center. Methods: The study sample included 507 patient charts. Data collection included patient demographics, RF denervation sites at a level with metallic hardware, and all serious RF-related complications that could be attributable to heated metallic hardware. The research team developed medical-chart abstraction criteria for each of the following categorized complications: a) superficial burns, b) deep burns, c) denervation of dorsal ramus, d) denervation of ventral ramus, and e) coagulation of a spinal vascular structure. Results: Of the 36 patients who met the inclusion criteria for this study, 43.6% were men and 56.4% were women. The mean age was 59.5 years old, with an age range of 25 to 87 years. There were a total of 56 ablations performed at a level with metallic spinal hardware, of which 11 were cervical, 44 were lumbar, and 1 was thoracic . There were zero documented complications found among our patient population in any of the 5 categories of serious complications. Limitations: As a retrospective chart review, this study was dependent on the availability and accuracy of medical records. Chart abstraction criteria for each outcome measure were developed by the research team without scientific testing. Conclusions: There have been no reported complications attributable to hardware temperature increases when performing medial branch RFNs at the level of a pedicle screw. For safety, it is important to use multiplanar fluoroscopic imaging techniques to ensure that the RFN cannula is not in contact with the pedicle screw. Key Words: Radiofrequency neurotomy, medial branch nerve ablation, safety, thermal injuries, metallic spinal hardware, pedicle screws, lateral mass screws, cervical facet joints, severe complications, adverse events

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Complications of Lumbar Facet and Medial Branch Blocks and Ablations

Dağıstan¹,

Akbaş²

2022

Complications of Pain‐Relieving Procedures

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Safety of Lumbar Spine Radiofrequency Procedures in the Presence of Posterior Pedicle Screws: Technical Report of a Cadaver Study

Cited by 13 publications

References 6 publications

Safety and Efficacy of Lumbar Spine Radiofrequency Neurotomy in the Presence of Posterior Pedicle Screws.

Safety and Efficacy of Lumbar Spine Radiofrequency Neurotomy in the Presence of Posterior Pedicle Screws.

A Retrospective Review of Spinal Radiofrequency Neurotomy Procedures in Patients with Metallic Posterior Spinal Instrumentation – Is it Safe?

Complications of Lumbar Facet and Medial Branch Blocks and Ablations

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