(372) Efficacy of sarapin use after medial branch radiofrequency denervation

2014 ◽  
Vol 15 (4) ◽  
pp. S69
Author(s):  
Y. Lu ◽  
R. Hamill-Ruth
Keyword(s):  
Medial Branch ◽  
Radiofrequency Denervation

Multicenter, Randomized, Comparative Cost-effectiveness Study Comparing 0, 1, and 2 Diagnostic Medial Branch (Facet Joint Nerve) Block Treatment Paradigms before Lumbar Facet Radiofrequency Denervation

2010 ◽  
Vol 113 (2) ◽  
pp. 395-405 ◽  
Author(s):  
Steven P. Cohen ◽  
Kayode A. Williams ◽  
Connie Kurihara ◽  
Conner Nguyen ◽  
Cynthia Shields ◽  
...  
Keyword(s):  
Positive Response ◽  
The United States ◽  
Successful Outcome ◽  
Medial Branch ◽  
Cost Effective Treatment ◽  
Pain Clinics ◽  
Radiofrequency Denervation ◽  
Diagnostic Block ◽  
Group 2 ◽  
Group 1

Background Among patients presenting with axial low back pain, facet arthropathy accounts for approximately 10-15% of cases. Facet interventions are the second most frequently performed procedures in pain clinics across the United States. Currently, there are no uniformly accepted criteria regarding how best to select patients for radiofrequency denervation. Methods A randomized, multicenter study was performed in 151 subjects with suspected lumbar facetogenic pain comparing three treatment paradigms. Group 0 received radiofrequency denervation based solely on clinical findings; group 1 underwent denervation contingent on a positive response to a single diagnostic block; and group 2 proceeded to denervation only if they obtained a positive response to comparative blocks done with lidocaine and bupivacaine. A positive outcome was predesignated as > or =50% pain relief coupled with a positive global perceived effect persisting for 3 months. Results In group 0, 17 patients (33%) obtained a successful outcome at 3 months versus eight patients (16%) in group 1 and 11 (22%) patients in group 2. Denervation success rates in groups 0, 1, and 2 were 33, 39, and 64%, respectively. Pain scores and functional capacity were significantly lower at 3 months but not at 1 month in group 2 subjects who proceeded to denervation compared with patients in groups 0 and 1. The costs per successful treatment in groups 0, 1, and 2 were $6,286, $17,142, and $15,241, respectively. Conclusions Using current reimbursement scales, these findings suggest that proceeding to radiofrequency denervation without a diagnostic block is the most cost-effective treatment paradigm.

Lumbar zygapophysial (facet) joint radiofrequency denervation success as a function of pain relief during diagnostic medial branch blocks: a multicenter analysis

2008 ◽  
Vol 8 (3) ◽  
pp. 498-504 ◽  
Author(s):  
Steven P. Cohen ◽  
Milan P. Stojanovic ◽  
Matthew Crooks ◽  
Peter Kim ◽  
Rolf K. Schmidt ◽  
...  
Keyword(s):  
Pain Relief ◽  
Facet Joint ◽  
Medial Branch ◽  
Radiofrequency Denervation ◽  
Multicenter Analysis

Medial Branch Blocks or Intra-Articular Injections as a Prognostic Tool Before Lumbar Facet Radiofrequency Denervation

2015 ◽  
Vol 40 (4) ◽  
pp. 376-383 ◽  
Author(s):  
Steven P. Cohen ◽  
Jee Youn Moon ◽  
Chad M. Brummett ◽  
Ronald L. White ◽  
Thomas M. Larkin
Keyword(s):  
Medial Branch ◽  
Prognostic Tool ◽  
Radiofrequency Denervation ◽  
Lumbar Facet

scholarly journals Case Report: Lumbar Medial Branch Radiofrequency Neurotomy in a Patient with Deep Brain Stimulator

2020 ◽  
pp. 175-178
Author(s):  
Lisa V. Doan
Keyword(s):  
Back Pain ◽  
Case Report ◽  
Facet Joint ◽  
Disease Status ◽  
Medial Branch ◽  
Deep Brain Stimulator ◽  
Radiofrequency Neurotomy ◽  
Bipolar Radiofrequency ◽  
Radiofrequency Denervation ◽  
Deep Brain

Background: The prevalence of implantable electronic devices, particularly deep brain stimulators (DBS), is increasing worldwide. To date, there has been limited research on the safety of radiofrequency neurotomy for lumbar facet joint pain in patients with implanted DBS. Furthermore, there are no clear guidelines on the management of DBS prior to radiofreqeuency neurotomy. Case Report: We present the case of a patient with Parkinson’s disease status post implantation of DBS for management of symptoms. Appropriate safety precautions were taken prior to and following the treatment procedure for the patient. Prior to the procedure, consultation with a device technical representative took place and the patient’s device was switched to “surgery mode.” This patient then underwent bipolar radiofrequency denervation of the bilateral lumbar medial branches with significant improvement in her pain and without any adverse effects upon postprocedure exam. Conclusion: We propose several steps and precautions when employing radiofrequency denervation in a patient with history of prior DBS implantation. By taking these precautions, radiofrequency denervation can safely be used in patients with DBS for the management of lower back pain. Key words: Deep brain stimulator, denervation, low back pain, Parkinson’s, radiofrequency neurotomy, safety

scholarly journals The Effectiveness of Endoscopic Radiofrequency Denervation of Medial Branch for Treatment of Chronic Low Back Pain

2014 ◽  
Vol 56 (4) ◽  
pp. 338 ◽  
Author(s):  
Sun Yoon Jeong ◽  
Jin Sung Kim ◽  
Won Suh Choi ◽  
Jung Woo Hur ◽  
Kyoung Sik Ryu
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Medial Branch ◽  
Low Back ◽  
Radiofrequency Denervation

Endoscopic 4-MHz Radiofrequency Treatment of Facet Joint Syndrome Is More Than Just Denervation: One Incision for Three Facets

2020 ◽  
Vol 81 (03) ◽  
pp. 238-242
Author(s):  
Christian Woiciechowsky ◽  
Leonie Mercedes Richter
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Retrospective Study ◽  
Chronic Low Back Pain ◽  
Facet Joint ◽  
Pain Reduction ◽  
Surrounding Tissue ◽  
Medial Branch ◽  
Low Back ◽  
Radiofrequency Denervation

Abstract Background and Study Aims Low back pain is well documented as an extremely common health problem. The most frequently used treatment is radiofrequency denervation for chronic low back pain. However, different clinical studies could only show a limited to no improvement regarding the decrease of pain intensity and duration of the effect. The main reasons for these limited effects seem to be due to the size of the lesion and difficulties in locating the exact placement of the cannula near the medial branch as well as or additional pathologies. Using an endoscope, it is possible to coagulate the facet joints and the medial branch under visual control and consider other pathologies such as extraspinal synovial cysts. Patients In this retrospective study, we included 28 patients with low back pain, with a duration > 6 months and a 50% pain reduction on the numeric analog scale (NAS) after a diagnostic block. All patients received endoscopic facet joint denervation of three facets on the left and right side using only one incision on each side with an exploration of the surrounding tissue. Telephone interviews were conducted with all patients. The outcome was determined with Odom's criteria, percentage reduction NAS, subjective assessment of the patient, and duration of the effect. Results According to Odom's criteria, 68% of the patients showed “acceptable” to “excellent” results and confirmed that denervation helped them manage their daily lives better. The average pain reduction in the responder group was 47% with an average duration of 7.8 months. Conclusion In this retrospective study, we demonstrated the practicability and effectiveness of the endoscopic facet joint denervation procedure in the treatment of chronic low back pain using only one incision for three facets. Further studies should investigate if this procedure is more effective than percutaneous radiofrequency denervation.

scholarly journals Best practice in radiofrequency denervation of the lumbar facet joints: a consensus technique

2019 ◽  
Vol 14 (1) ◽  
pp. 47-56 ◽  
Author(s):  
Sam Eldabe ◽  
Anisah Tariq ◽  
Sherdil Nath ◽  
Ashish Gulve ◽  
Hugh Antrobus ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Best Practice ◽  
Controlled Trial ◽  
Medial Branch ◽  
Low Back ◽  
Facet Joints ◽  
Radiofrequency Denervation ◽  
Lumbar Facet ◽  
Lumbar Facet Joints

Background: Radiofrequency denervation is used to treat selected people with low back pain. Recent trials have been criticised for using a sub-optimal intervention technique. Objectives: To achieve consensus on a best practice technique for administering radiofrequency denervation of the lumbar facet joints to selected people with low back pain. Study design: A consensus of expert professionals in the area of radiofrequency denervation of the lumbar facet joints. Methods: We invited a clinical member from the 30 most active UK departments in radiofrequency pain procedures and two overseas clinicians with specific expertise to a 1 day consensus meeting. Drawing on the known anatomy of the medial branch, the theoretical basis of radiofrequency procedures, a survey of current practice and collective expertise, delegates were facilitated to reach consensus on the best practice technique. Results: The day was attended by 24 UK and international clinical experts. Attendees agreed a best practice technique for the conduct of radiofrequency denervation of the lumbar facet joints. Limitations: This consensus was based on a 1 day meeting of 24 clinical experts who attended and took part in the discussions. The agreed technique has not been subject to input from a wider community of experts. Conclusions: Current best practice for radiofrequency denervation has been agreed for use in a UK trial. Group members intend immediate implementation in their respective trusts. We propose using this in a planned Randomised Controlled Trial (RCT) of radiofrequency denervation for selected people with low back pain.

scholarly journals Interventional Pain Medicine Practice in the UK and the USA: A Survey of 242 Pain Physicians

2020 ◽  
Vol 2;23 (4;2) ◽  
pp. 127-134
Author(s):  
Sanjeeva Gupta
Keyword(s):  
United Kingdom ◽  
Pain Relief ◽  
Medial Branch ◽  
Pain Medicine ◽  
Antithrombotic Agents ◽  
Lumbar Level ◽  
The United Kingdom ◽  
Radiofrequency Denervation ◽  
The Us ◽  
The Uk

Background: Pain medicine practices vary across different regions within a country and between countries. Objectives: The objective of the survey was to study the variation in interventional pain medicine practices in the United Kingdom (UK) and the United States (US). Methods: A survey was designed in 2019 on Survey Monkey®. Pain physicians from the UK and the US were invited to respond. Results: A total of 120 responses were received from pain physicians in the UK and 122 from the US. Twenty-six percent and 90% of pain physicians in the UK and US, respectively, are in full-time pain medicine practice. There was marked variation in the utilization of diagnostic medial branch blocks before performing radiofrequency denervation (RFD) between the UK and the US. In the UK, 42% of pain physicians, and 50% in the US, use a 20-gauge or a 22-gauge radiofrequency needle for lumbar RFD. Around 30% to 50% of pain physicians, both in the UK and the US, discontinued antithrombotic agents before medial branch blocks at all the spinal levels. Around 50% of pain physicians in the UK and US are stopping anticoagulants before lumbar and cervical RFD. Over 95% of UK and US respondents stopped antithrombotic agents for interlaminar and transforaminal epidural injections along the spine. At the lumbar level, 51% of pain physicians in the UK and 47% in the US use a particulate steroid for the initial lumbar transforaminal epidural injection (TFESI); and 4% and 14% in the UK and US, respectively, use a particulate steroid for initial cervical TFESI. Eight percent of pain physicians in the UK and 20% from the US would switch to a particulate steroid if the initial TFESI with a nonparticulate steroid did not provide satisfactory pain relief. Ten percent of pain physicians from the United Kingdom and 20% from the US believed that this switch provides better pain relief. Limitations: Interventional pain physicians from the UK and the US were invited to respond. This may not reflect global practice. Conclusions: Our survey has highlighted the wide variation in interventional pain medicine practices both in the UK and the US. The relevant governing bodies in the UK and in the US should encourage clinicians to use at least an 18-gauge radiofrequency needle for RFD at the lumbar level. Discontinuing antithrombotic agents for the lumbar medial branch block is not justifiable. Pain physicians must discuss the advantages and disadvantages of using a nonparticulate over a particulate steroid preparation with the patient before performing TFESI as a standard procedure during the consenting process. Key words: Antithrombotic agents, epidural steroid, medial branch blocks, pain practice variations, particulate and nonparticulate steroids, radiofrequency denervation, spinal interventions

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