Ball Richard D
Neuromuscular and Rehabilitation Associates of Northern Michigan, Traverse City, MI.
Pain Physician. 2014 Mar-Apr;17(2):E175-211.
Radiofrequency ablation (RFA) is a safe and effective pain therapy used to create sensory dysfunction in appropriate nerves via thermal damage. While commonly viewed as a simple process, RF heating is actually quite complex from an electrical engineering standpoint, and it is difficult for the non-electrical engineer to achieve a thorough understanding of the events that occur. RFA is highly influenced by the configuration and properties of the peri-electrode tissues. To rationally discuss the science of RFA requires that examples be procedure-specific, and lumbar RFA is the procedure selected for this review. Adequate heating of the lumbar medial branch has many potential failure points, and the underlying science is discussed with recommendations to reduce the frequency of failure in heating target tissues. Important technical details of the procedure that are not generally appreciated are discussed, and the status quo is challenged on several aspects of accepted technique. The rationale underlying electrode placement and the limitations of RF heating are, for the most part, commonly misunderstood, and there may even need to be significant changes in how lumbar radiofrequency rhizotomy (RFR) is performed. A new paradigm for heating target tissue may be of value. Foremost in developing best practices for this procedure is avoiding pitfalls. Good RF heating and medial branch lesioning are the rewards for understanding how the process functions, attention to detail, and meticulous attention to electrode positioning.
射频消融术（RFA）是一种安全有效的疼痛治疗方法，通过热损伤在合适的神经中造成感觉功能障碍。虽然通常被视为一个简单的过程，但从电气工程的角度来看，射频加热实际上相当复杂，非电气工程师很难全面理解所发生的事件。RFA受电极周围组织的结构和特性影响很大。为了合理地讨论RFA的科学原理，需要针对特定的手术过程举例，而腰椎RFA就是本次综述所选择的手术。对腰椎内侧支进行充分加热存在许多潜在的失败点，本文将讨论其背后的科学原理，并提出减少加热目标组织失败频率的建议。文中还讨论了该手术中一些通常未被重视的重要技术细节，并对公认技术的几个方面提出了质疑。电极放置的基本原理和射频加热的局限性在很大程度上通常被误解，甚至腰椎射频神经根切断术（RFR）的实施方式可能需要有重大改变。一种加热目标组织的新范式可能具有价值。在为该手术制定最佳实践时，首要的是避免陷阱。良好的射频加热和内侧支损伤是理解该过程如何运作、注重细节以及精心关注电极定位的回报。
