Spine & Pain Institute of New York, New York City, New York; Department of Anesthesiology, New York University Langone Medical Center, New York City, New York.
Department of Rehabilitation and Regenerative Medicine, New York Presbyterian Hospital, New York, NY.
Pain Physician. 2020 Sep;23(5):E507-E516.
Radiofrequency ablation (RFA) of the medial branches of the dorsal rami has been reported to relieve facet joint-related back pain for 6 months to 1 year in 60% of patients. Although providing benefit in a significant proportion of patients, there remains a group of patients who do not experience any pain relief from RFA or experience only benefit from the ablation for a short period. Failure of RFA has been attributed to technical failure of coagulating the nerve or coagulation of a minimal section of the nerve, allowing for early reinnervation. Increasing the success rate and duration of relief may require techniques that increase the likelihood of successful nerve ablation over a relevant distance by maximizing lesion size.
The aim of this technical note is to detail a modification to the current commonly used lumbar medial branch radiofrequency (RF) denervation approach to increase lesion size.
This is a technical report describing a novel two-needle approach to lumbar RF medial branch denervation.
Large private interventional pain management institute.
A dual needle placement of two 10-mm active tip RF cannulas separated by 6 mm is used to optimally contact the superior articular process (SAP) from its ventral to dorsal borders, which encompasses the anticipated course of the medial branch nerves.
The described technique creates a lesion that we estimate to be 11.0-mm wide and 11.6-mm long along the course of the medial branch adjacent to the SAP ensuring adequate coverage and treatment.
This report does not encompass a systematic evaluation of the clinical safety and efficacy of the two-needle RFA approach. Future studies will have to assess the long-term efficacy and safety of the approach.
The detailed two-needle approach to lumbar RF medial branch denervation appears to be promising in terms of projected treatment success by coagulating a large volume of tissue, in a cost- and time-efficient manner.
射频消融（RFA）治疗背根支内侧支已被报道能在 60%的患者中缓解关节突关节相关腰痛 6 个月至 1 年。尽管在很大一部分患者中提供了益处，但仍有一部分患者没有从 RFA 中获得任何缓解，或者仅在很短的时间内从消融中获益。RFA 的失败归因于神经凝固技术的失败或仅凝固了神经的最小部分，从而允许早期再神经支配。增加 RFA 的成功率和缓解持续时间可能需要通过最大化病变大小来增加在相关距离内成功消融神经的可能性的技术。
本技术说明的目的是详细描述一种改良的当前常用的腰椎内侧支射频（RF）去神经方法，以增加病变大小。
这是一项技术报告，描述了一种新的腰椎 RF 内侧支去神经的双针方法。
大型私立介入性疼痛管理研究所。
使用两个 10 毫米的主动尖端 RF 套管的双针放置，间隔 6 毫米，以最佳地接触从上关节突（SAP）的腹侧到背侧边界，这包括内侧支神经的预期路径。
所描述的技术创建了一个病变，我们估计在 SAP 附近的内侧支的相邻路径上宽 11.0 毫米，长 11.6 毫米，确保了足够的覆盖和治疗。
本报告不包括对双针 RFA 方法的临床安全性和疗效的系统评估。未来的研究将不得不评估该方法的长期疗效和安全性。
腰椎 RF 内侧支去神经的详细双针方法似乎在通过凝固大量组织的方式在成本和时间效率方面具有有前景的治疗成功率。
