Radiofrequency
Thermocoagulation
İİİİİİİİİİİİİİİ Electrical
heating has a number of advantages including the circumscribed and predictable
nature of the lesion. A number of investigators over the years have attempted
to obtain reproducible heat lesions using electrical devices dating back to the
early part of the century. In 1952, Radionics founder Bernard J. Cosman
developed the first radiofrequency generator system. For over 30 years
radiofrequency (RF) lesions have been commonly used to alleviate chronic pain and
to make lesions in the central nervous system for other purposes such as the
treatment of parkinsonism.[1],[2]
The therapy has been FDA approved since prior to May 28th,1976. The
procedure is well understood and accepted in the medical community, for the treatment
of conditions for which other forms or treatment are not desirable or accepted.
Since there is no effective surgeryİ for
the treatment of mechanical pain arising from the zygapophyseal joint (Facet
Joint), radiofrequency thermocoagulation offers a safe and cost effective
alternative to repeated Facet joint blocks with local anesthetics and steroids.
The procedure is not considered to be investigational or experimental. The CPT 2000 was revised and new codes were
created to delineate Radiofrequency Facet procedures performed at the lumbar,
sacral, cervical, and thoracic levels. The codes are: 64626; 64627; 64470; and
64472. These codes have been created with the help of the American Medical
Association. No codes are ever created for ìinvestigational or experimentalî
procedures or treatments, which further proves the acceptance of such therapy
by the medical community.
İİİİİİİİİİİİİİİ The International Spinal Injection Society (ISIS) has recognized the effectiveness of Radiofrequency Thermocoagulation for the treatment of chronic facet (zygapophysial) joint pain:
…
ìTreatment was successful with statistically significant improvements
in the visual analog pain scale, Roland-Morris disability scale, physical
function and bodily pain sub-scales of the SF-36 questionnaire, and the McGill
pain questionnaire. Technical neurotomy success was 90.5% when comparing pre
vs. post multifidi denervation results. Overall treatment success (defined as
50% or more pain relief at 1 year post-neurotomy) was 87%. 33% of subjects had
100% pain reduction, 27% had a 76-99% pain reduction and 27% had a 50-75%
reduction in pain at 1 year post-neurotomy.î[3]
…
ìRadiofrequency neurotomy remains the only practical and validated
treatment for cervical facet joint painî[4]
…
ìPercutaneous radiofrequency facet denervation is simple and safe,
still worth considering in patients with disabling spinal pain that fails to
respond to conservative treatment.î[5]
…
ìRadiofrequency lumbar zygapophysial joint denervation results in a
significant alleviation of pain and functional disability in a select group of
patients with chronic low back pain, both on a short-term and a long-term
basis.î[6]
… ìDuring the period from March 1992 to June 1996, we performed percutaneous radiofrequency (RF) facet rhizotomy in 324 patients with low back pain. Employing the lesion generator, we coagulated branches of the zygapophyseal nerve to treat low back pain. The follow-up period was 6-51 months (average: 22.5 months). There were no complications during the procedure and the follow-up period and no poor results were observed. Two-hundred and thirty-one patients (103 females and 128 males) had mechanical low back pain syndrome and showed marked improvement of pain after the procedure, including 29 cases with previous spinal surgery. We concluded that percutaneous RF facet rhizotomy is a safe and effective procedure for low back pain patients, especially for those with mechanical low back pain syndrome.î[7]
… ìOver a 10-year period, 142 percutaneous radiofrequency facet rhizotomies were performed at a suburban community hospital on patients with incapacitating low back pain after various modalities of conservative treatment had failed. Neuroradiologic studies were negative or failed to reveal a herniated disk in all patients. The initial series reported in 1986 included 56 patients who had undergone previous spinal surgery and 59 patients who had lumbosacral radiculitis. An additional 27 patients with lumbosacral radiculitis have been treated. The combined use of fine thermocouple electrodes, image intensifier, nerve stimulator, and radiofrequency lesion generator provided a simple and safe technique for the relief of pain. Improvement, assessed by reduced medication requirement and increased employment, occurred in 60% of the patients.î[8]
… ìA statistical analysis of 61 consecutive patients who underwent facet denervation for chronic low back pain and sciatica showed that the average patient improved with lower pain estimates and use of narcotics, while activity levels increased. At 1-2 year follow-up there was a trend for patients to report an increase in their pain estimate although they maintained consistently high activity levels and low analgesic intake.î[9]
…
ìPercutaneous RF facet denervation is a valid,
low-risk means of treating 'mechanical' pain syndromes in previously unoperated
patients with back and/or leg pain. In the series of 126 patients, reported
long-term overall success was 42%. With improved technique and patient
selection, success rate has increased to 67%. This procedure appears to be
increasing in clinical value as a more conservative means of treating certain
back pain problems, thus avoiding definitive surgery.î[10]
…
ìApproximately 50% to 67% of well selected
patients with chronic, mechanically caused low back pain achieve moderate to
significant reduction in pain or improved range of motion following
radiofrequency facet rhizotomy.î[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43]
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