From the *Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; and †Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Reg Anesth Pain Med. 2014 Jan-Feb;39(1):61-6. doi: 10.1097/AAP.0000000000000032.
Chronic low back pain related to degenerative spondylosis is commonly managed by the radiofrequency ablation of sensory nerves. Fluoroscopic guidance has been considered mandatory to ensure placement of the active tip of the cannula parallel to the nerve to provide adequate neurolysis. Conversely, analgesic (or diagnostic) blockade is usually accomplished by placing the needle perpendicular to the nerve using either fluoroscopy or ultrasound (US) guidance. The recently introduced disposable equipment of internally cooled radiofrequency allows the denervation procedure to be performed similarly to the routine diagnostic block. Consequently, US may now potentially be used for image-guided radiofrequency neurotomy. We sought to compare the accuracy using a novel US-based technique with the traditional fluoroscopy-guided placement.
The proof of concept study was performed using a magnetic positioning US-guided system. The precision of needle placements was compared with the standard fluoroscopic guidance. The primary outcome of this study was defined as the procedural accuracy. Procedural and radiation exposure time was also recorded. In addition, projected operational expenses were calculated.
Ultrasound-guided procedural accuracy reached 97%. Both the imaging and procedure times were similar between the 2 forms of imaging guidance. Of significant importance, the US-guided approach (no radiation exposure) was quantitatively advantageous over fluoroscopy-guidance, which required an average of 170 seconds of radiation per procedure. Thus, the US method seems to be cost effective.
A magnetic positioning system allows accurate and quick US-guided placement of radiofrequency cannula to the desired anatomical targets, sparing patients and personnel from exposure to ionized radiation.
与退行性脊柱关节炎相关的慢性腰痛通常通过射频消融感觉神经来治疗。为了确保射频消融管的活性尖端与神经平行放置，以提供充分的神经松解，通常需要透视引导。相反，镇痛（或诊断）阻滞通常通过将针垂直于神经放置来完成，透视或超声（US）引导均可。最近推出的一次性内部冷却射频设备允许将去神经程序与常规诊断阻滞类似地进行。因此，US 现在可能有潜力用于图像引导射频神经切断术。我们旨在比较使用新型 US 引导技术与传统透视引导放置的准确性。
该概念验证研究使用了基于磁定位的 US 引导系统。比较了针放置的准确性与标准透视引导。本研究的主要结果定义为程序准确性。还记录了程序和辐射暴露时间。此外，还计算了预计运营费用。
超声引导程序的准确性达到 97%。两种成像引导方式的成像和手术时间相似。重要的是，超声引导方法（无辐射暴露）在定量上优于需要平均 170 秒辐射的透视引导，因此，超声方法似乎具有成本效益。
基于磁定位的系统允许射频管的准确和快速的超声引导放置到所需的解剖目标，使患者和医务人员免受电离辐射的暴露。
