Radiofrequency Guidelines

1.ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Lumbar Facet Neurotomy (Medial Branch):

Needle: 100-mm insulated with 5-mm exposed tip

Impedance: 300-700 ohms

Sensory: present < 1.0 volts @ 50Hz

Motor: absent < 2.5 volts @ 2 Hz

Temp.: 80ƒC    Time: 60 sec.

2.ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Sacroiliac Joint Neurotomy (Medial Branch):

Bipolar electrode wires needed

Needle: 100-mm insulated with 10-mm exposed tip

*Distance between needle tips should not exceed 5x the diameter of the needle.

Temp.: 80ƒC    Time: 60 sec.

*Make sure to get the S₂ contribution (S₂ Neurotomy)

3.ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Lumbar Disk Radiofrequency:

Part I: (Ramus Communicans Rhizotomy):

Needle: 150-mm insulated with 5-mm exposed tip

*The Ramus Communicans nerve runs @ the lower ‡ of the vertebral body.

Sensory: present < 1.0 volts @ 50Hz

Motor: absent < 2.5 volts @ 2 Hz

Temp.: 80ƒC    Time: 60 sec.

Part II: (Disk) (Annuloplasty/Nucleoplasty):

Needle: 150-mm insulated with 10- or 15-mm active tip

Motor: absent < 2.5 volts @ 2 Hz

If 10-mm active tipà Temp.: 80ƒC    Time: 4 minutes

If 15-mm active tipà Temp.: 70ƒC    Time: 4 minutes

ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ SpineCath System (Annuloplasty/Nucleoplasty):

ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ 5 minutes @ 50†C

ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ 5 minutes @ 55†C

ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ 5 minutes @ 60†C

ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ 2 minutes @ 65†C

ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Total time: 17 minutes

4.ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Dorsal Root Ganglionotomy:

Needle: 150-mm insulated with 5-mm active tip

Sensory: present < 1.0 volts @ 50Hz

Ideal Sensory: between 0.4 and 0.7 Volts @ 50 Hz

Avoid Sensory: < 0.3 volts @ 50 Hz

*Voltage needed for motor @ 2 Hz should be = to 2x sensory @ 50 Hz

Motor: absent < 2.5 volts @ 2 Hz

Temp.: 67-70ƒC    Time: 60 sec.

*Triamcinolone 40 mg thru cannula, immediately after burn

*Use ìBowel prepî for this procedure

*Since the development of ìPulsed Radiofequencyî, this technique is preferred for this particular procedure:

ÝÝÝÝÝÝÝÝÝÝÝÝÝ Temp.: 42ƒC    Time: 120 sec.ÝÝÝÝ ìPulsed RFî

5.ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Sacral Dorsal Root Ganglionotomy:

*Use ìBowel prepî

*Use Neurography with Isovue 300 to visualize the structures

-Burr hole ‡ way between posterior S₁ foramen and craniad border of sacrum, using a K wire.

Needle: 150-mm insulated with 5-mm active tip

Sensory: present < 1.0 volts @ 50Hz

Ideal Sensory: between 0.4 and 0.7 Volts @ 50 Hz

Avoid Sensory: < 0.3 volts @ 50 Hz

*Voltage needed for motor @ 2 Hz should be = to 2x sensory @ 50 Hz

Motor: absent < 2.5 volts @ 2 Hz

Temp.: 67-70ƒC    Time: 60 sec.

*Triamcinolone 40 mg thru cannula, immediately after burn

*For the S₂, the ganglion resides 2 way between the S₁ and S₂ foramens.

*For the S₅, the ganglion resides 1-cm inferior to the S₂ foramen, along the midline of the sacrum.

*Sensory will be felt over the area of the coccyx.

*Test to avoid motor stimulation of the external anal   sphincter

*Since the development of ìPulsed Radiofequencyî, this technique is preferred for this particular procedure:

ÝÝÝÝÝÝÝÝÝÝÝÝÝ Temp.: 42ƒC    Time: 120 sec.ÝÝÝÝ ìPulsed RFî

6.ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Cervical Ganglionotomy:

Temp.: 66-68ƒC    Time: 60 sec.

*Since the development of ìPulsed Radiofequencyî, this technique is preferred for this particular procedure:

ÝÝÝÝÝÝÝÝÝÝÝÝÝ Temp.: 42ƒC    Time: 120 sec.ÝÝÝÝ ìPulsed RFî

7.ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Cervical Disk:

Needle: 50- or 100-mm insulated with 5-mm active tip

Temp.: 80ƒC    Time: 4 minutes *increase temp. Over 30 sec

*Use right-sided approach

8.ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ SGB:

Temp.: 80ƒC    Time: 30 sec.

Motor: absent < 2.5 volts @ 2 Hz

*Test that the patientís ability to articulate the letter ìEî has not changed, this would mean that we are too close to the recurrent laryngeal nerve.

*@ the same time, confirm that there is no movement of the diaphragm, which would be mediated by the phrenic nerve.

9.ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Sphenopalatine Ganglionotomy:

Needle: 100-mm insulated with 5-mm active tip

Sensory: present < 1.0 volts @ 50Hz sensation @ nose

Temp.: 80ƒC    Time: 60 sec.

*Create lesion then advance 1-mm medially, repeat x3

*Since the development of ìPulsed Radiofequencyî, this technique is preferred for this particular procedure:

ÝÝÝÝÝÝÝÝÝÝÝÝÝ Temp.: 42ƒC    Time: 120 sec.ÝÝÝÝ ìPulsed RFî

10.ÝÝÝÝÝÝÝÝÝÝÝÝÝ Trigeminal Ganglionotomy:

*Prophylactic antibiotics 1hr prior to procedure

Sensory: present < 0.5 volts @ 50Hz

Motor: masseter should not move < 0.7-1.0 volts @ 2 Hz

Temp.: 62-65ƒC    Time: 60 sec.

*Lesion should be repeated with increasing temp. X3

*Admit to hospital X 24hrs

*Dexamethasone IV approx. 0.4mg/kg X 48hrs

*Since the development of ìPulsed Radiofequencyî, this technique is preferred for this particular procedure:

ÝÝÝÝÝÝÝÝÝÝÝÝÝ Temp.: 42ƒC    Time: 120 sec.ÝÝÝÝ ìPulsed RFî

11.ÝÝÝÝÝÝÝÝÝÝÝÝÝ Lumbar Sympathectomy:

*L₂, L₃, L₄, and L₅, if the foot is also involved

Needle: 150-mm insulated with 10-mm active tip

Sensory: present < 1.0 volts @ 50Hz @ low back

Motor: negative LE @ < 3.0 volts @ 2 Hz

*Create 15-mm ìstripsî

Temp.: 80ƒC    Time: 60 sec.

12.ÝÝÝÝÝÝÝÝÝÝÝÝÝ Thoracic Sympathectomy:

*@T_1-2, & T_2-3

Needle: 150-mm insulated with 10-mm active tip

Sensory: present < 1.0 volts @ 50Hz @chest & back

Motor: negative intercostals @ < 3.0 volts @ 2 Hz

*Create 15-mm ìstripsî

Temp.: 80ƒC    Time: 60 sec.