Jasper Joseph F
Advanced Pain Medicine Physicians, PLLC, Tacoma, WA 98465-1613, USA.
Pain Physician. 2008 Nov-Dec;11(6):863-75.
Radiofrequency neurolysis is a common technique used in the treatment of chronic pain, particularly facet (zygapophyseal joint) arthralgia. A needle-like cannula is insulated except for the exposed active tip, which is positioned as parallel and adjacent as possible to the targeted nerve branch. Via an inserted probe connected to a radiofrequency generator, energy flowing from the tip of the cannula creates a heat lesion in the 80 - 85 degree Celsius range mostly about the length of the exposed active tip and in proportion to the diameter of the probe. The common active tip lengths used for neurolysis are 5mm or 10mm. The cannulae are FDA approved. The manufacturer advises physicians not to bend or otherwise modify a cannula prior to use. The cannulae are available straight or bent, sharp and blunt. The technique is guided under C-arm fluoroscopy. X-rays passing through the patient demonstrate in 2 dimensions the projected relative radio-opaque bony landmarks and the metallic cannula. Most currently available cannulae are uniform in their radio-opacity from tip to hub. The physician must make an educated guess as to the portion of the cannula that will be making the lesion in relationship to the bony landmark.
A new radiofrequency cannula with a radio-opaque marker (ROC) delineates the proximal end of the active tip. The cannula was used in a phantom model. Images were reproduced with explanation of the potential advantage of the new device.
The marker on the new cannula was visible and did help delineate the active tip as well as its orientation. It was also helpful in making sequential lesions at the same nerve using a "tip to tail" repositioning technique.
The ROC did represent an improvement over standard cannulae to optimize visualization of cannula and thus lesion placement using a phantom model. The applications described were only for conventional or "hot" RF.
射频神经溶解术是治疗慢性疼痛，尤其是小关节（关节突关节）疼痛的常用技术。针状套管除暴露的有源尖端外均绝缘，该有源尖端尽可能平行且靠近目标神经分支定位。通过连接到射频发生器的插入探头，从套管尖端流出的能量在80 - 85摄氏度范围内产生热损伤，损伤范围主要围绕暴露的有源尖端长度，并与探头直径成比例。用于神经溶解术的常见有源尖端长度为5毫米或10毫米。这些套管已获得美国食品药品监督管理局（FDA）批准。制造商建议医生在使用前不要弯曲或以其他方式修改套管。套管有直的或弯曲的，尖端有尖锐的和钝的。该技术在C形臂荧光透视引导下进行。穿过患者的X射线在二维上显示出相对不透射线的骨性标志和金属套管的投影。目前大多数可用的套管从尖端到针座的不透射线性是均匀的。医生必须根据骨性标志对将产生损伤的套管部分进行合理猜测。
一种带有不透射线标记（ROC）的新型射频套管可描绘有源尖端的近端。该套管用于模拟模型。展示了图像并解释了新设备的潜在优势。
新套管上的标记清晰可见，确实有助于描绘有源尖端及其方向。它对于使用“从尖端到尾部”重新定位技术在同一神经上进行连续损伤也很有帮助。
在模拟模型中，ROC相对于标准套管确实有所改进，可优化套管的可视化，从而优化损伤放置。所描述的应用仅适用于传统或“热”射频。
