Advertisement

Acta Neurochirurgica

, Volume 158, Issue 5, pp 995–998 | Cite as

Percutaneous radiofrequency thermocoagulation of dorsal ramus branches as a treatment of “lumbar facet syndrome” - How I do it

  • Mattia PacettiEmail author
  • Pietro Fiaschi
  • Sergio Gennaro
How I Do it - Spine

Abstract

Background

Low back pain is an extremely common and often chronic condition. In some cases, this is due to an irritative arthropathy of zygapophyseal joint involving the medial branch of the dorsal ramus of the spinal nerve. Percutaneous radiofrequency thermocoagulation appears to be the most effective treatment to date, among a range of different treatments. In this paper, the technique is described as performed at out institution.

Methods

In supine position and under fluoroscopic control, a radiofrequency electrode is inserted into different articular zygapophyseal complexes to thermocoagulate ramifications of the medial branch of the dorsal primary ramus of the spinal nerve.

Conclusions

Fluoroscopic-guided percutaneous radiofrequency thermocoagulation of dorsal rami branches is a safe and reliable technique for the treatment of lumbar facet syndrome. Careful selection of patients based on clinical presentation and positive anesthetic block test are key points for an optimum outcome.

Keywords

Chronic low back pain Thermocoagulation Pain management Spine 

Notes

Compliance with ethical standards

Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

ESM 1

The attached video shows one step of the procedure. The cannula is positioned as described in the text, local anesthesia is injected, the probe is inserted, and the position is corrected under fluoroscopic control. Then thermocoagulation is performed. The probe is moved as described in the text and thermocoagulation is repeated. (MP4 167455 kb)

References

  1. 1.
    Bogduk N, Wilson AS, Tynan W (1982) The human lumbar dorsal rami. J Anat 134(Pt 2):383–397PubMedPubMedCentralGoogle Scholar
  2. 2.
    Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L (2007) Interventional techniques: Evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician 10:7–111PubMedGoogle Scholar
  3. 3.
    Burnham RS, Holitski S, Dinu I (2009) A prospective outcome study on the effects of facet joint radiofrequency denervation on pain, analgesic intake, disability, satisfaction, cost, and employment. Arch Phys Med Rehabil 90(2):201–5Google Scholar
  4. 4.
    Cohen SP, Hurley RW, Christo PJ, Winkley J, Mohiuddin MM, Stojanovic MP (2007) Clinical predictors of success and failure for lumbar facet radiofrequency denervation. Clin J Pain 23:45–52CrossRefPubMedGoogle Scholar
  5. 5.
    Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N (2000) Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine (Phila Pa 1976) 25(10):1270–1277CrossRefGoogle Scholar
  6. 6.
    MCKornick C, Kramarich SS, Lamer TJ, Todd Sitzman B (2004) Complications of lumbar facet radiofrequency denervation. Spine (Phila Pa 1976) 29(12):1352–1354CrossRefGoogle Scholar
  7. 7.
    North RB, Han M, Zahurak M, Kidd DH (1994) Radiofrequency lumbar facet denervation: analysis of prognostic factors. Pain 57:77–83CrossRefPubMedGoogle Scholar
  8. 8.
    Van Kleef M, Vanelderen P, Cohen SP, Lataster A, Van Zundert J, Mekhail N (2010) Pain originating from the lumbar facet joints. Pain Pract 10(5):459CrossRefPubMedGoogle Scholar
  9. 9.
    Walker BF (2000) The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord 13:205–217CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Mattia Pacetti
    • 1
    Email author
  • Pietro Fiaschi
    • 1
  • Sergio Gennaro
    • 2
  1. 1.School of Neurosurgery, IRCCS Ospedale San Martino- ISTUniversità di Torino, Università degli studi di GenovaGenoaItaly
  2. 2.U.O. Neurochirurgia, IRCCS Ospedale San Martino- ISTGenoaItaly

Personalised recommendations