scholarly journals Radiofrequency Neurolysis for Lumbar Pain Using a Variation of the Original Technique

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. 155-161
Author(s):  
Jorge Felipe Ramirez León
Keyword(s):  
High Frequency ◽  
Facet Joint ◽  
Joint Capsule ◽  
Thermal Therapy ◽  
Lumbar Pain ◽  
Radiofrequency Energy ◽  
Medial Branch ◽  
Zygapophysial Joint ◽  
One Year

Background: Zygapophysial joint arthrosis is a pathology related with axial lumbar pain. The most accepted treatment, after failure of medical management, is the thermal denervation of the medial branch. Nonetheless, the placement of the heat probe remains a challenge to surgeons, even when using the fluoroscope. Using a variation of Shealy’s and Bogduk’s original techniques, which includes ablation of the medial branch and the nerves present in the joint capsule, we hypothesize that we can obtain similar outcomes to those found in the literature. Objective: To present the results attained over the last 8 years in the treatment of axial lumbar pain from zygapophysial joints degeneration, by employing a variation of the lumbar medial branch neurotomy technique, called 360-degree facet rhizotomy with radiofrequency. Study Design: Retrospective evaluation. Setting: Spine Center – Minimally Invasive Surgery in Bogotá, Colombia. Methods: A medical chart review was conducted for patients diagnosed with axial lumbar pain from zygapophysial joint arthrosis and treated with 360-degree facet rhizolysis with a high frequency radiofrequency energy source between 2008 and 2014. Data were evaluated under modified MacNab and pre- and postoperative visual analog scale (VAS) criteria. Results: We obtained a total of 73 patients. The average population age was 58.6 years. The preoperative VAS obtained was 7.3, which changed to 1.7 one year after the procedure. The MacNab criteria 12 months after the surgery gave satisfactory outcomes (excellent and good) from 91.7% of the patients. Limitations: This retrospective study includes inherent limitations and only offers one year follow-up data. Conclusions: Thermal therapy for zygapophysial joint arthrosis constitutes a safe and effective technique. The one year follow-up data presented here show that the ablation of the medial branch and nerves present in the joint capsule leads to satisfactory results in a high percentage of patients. Key words: Zygapophysial joint, lumbar axial pain, high frequency radiofrequency, facet arthrosis, neurolysis, thermal therapy, facet joint thermocoagulation

What is the Effect of Lumbar Medial Branch Nerve Radiofrequency Ablation on Lumbar Spondylolisthesis: A Single-Center, Observational Study

2021 ◽  
Author(s):  
Trusharth Patel ◽  
Christopher Watterson ◽  
Anne Marie McKenzie-Brown ◽  
Boris Spektor ◽  
Katherine Egan ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Degenerative Spondylolisthesis ◽  
Lumbar Pain ◽  
Spinal Instability ◽  
Medial Branch ◽  
Single Center ◽  
Spine Imaging ◽  
Grade Ii ◽  
Lumbar Spondylolisthesis

Abstract Background Radiofrequency ablation (RFA) is a denervation therapy commonly performed for pain of facet etiology. Degenerative spondylolisthesis, a malalignment of the spinal vertebrae, may be a co-existing condition contributing to pain; yet the effect of RFA on advancing listhesis is unknown. To the extent that denervating RFA can weaken paraspinal muscles that provide stability to the spine, the therapy can potentially contribute to progressive spinal instability. Objectives To test the hypothesis that RFA of painful facets in the setting of spondylolisthesis may contribute to advancement of further degenerative spondylolisthesis. Methods Single-center, prospective, observational pilot study in an interventional pain practice. Fifteen participants with pre-existing degenerative Grade I or Grade II spondylolisthesis and coexisting axial lumbar pain underwent lumbar RFA encompassing spondylolisthesis level and followed with post-RFA imaging at 12 months and beyond to measure percent change in spondylolisthesis. Results The primary outcome was the percent advancement of spondylolisthesis per year measured on post-RFA lateral lumbar spine imaging compared to non-intervention baseline advancement of 2.6% per limited observational studies. Among the 15 participants enrolled, 14 completed the study (median age 66; 64.3% women; median BMI 33.5; mean follow-up time 23.9 months). The mean advancement of spondylolisthesis per year after RFA was 1.30% (95% CI -0.14 to 2.78%), with 9/14 below 1.25%. Conclusion Among patients with lumbar pain originating from facets in the setting of degenerative spondylolisthesis who underwent lumbar RFA, the observed advancement of spondylolisthesis is clinically similar to the baseline of 2.6% per year change. The study findings did not find a destabilizing effect of lumbar RFA in advancing spondylolisthesis in this patient population.

scholarly journals Accuracy of Diagnostic Lumbar Facet Joint Nerve Blocks: A 2-Year Follow-Up of 152 Patients Diagnosed with Controlled Diagnostic Blocks

2009 ◽  
Vol 5;12 (5;9) ◽  
pp. 855-866 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Joint Pain ◽  
Facet Joint ◽  
Low Back ◽  
Lumbar Facet Joint ◽  
Nerve Blocks ◽  
Facet Joint Pain ◽  
One Year ◽  
Lumbar Facet

Background: Lumbar facet joint pain is diagnosed by controlled diagnostic blocks. The accuracy of controlled diagnostic blocks has been demonstrated in multiple studies and confirmed in systematic reviews. Controlled diagnostic studies have shown an overall prevalence of lumbar facet joint pain in 31% of the patients with chronic low back pain without disc displacement or radiculitis, with an overall false-positive rate of 30% using a single diagnostic block. Study Design: An observational report of outcomes assessment. Setting: An interventional pain management practice setting in the United States. Objective: To determine the accuracy of controlled diagnostic blocks in managing lumbar facet joint pain at the end of 2 years. Methods: This study included 152 patients diagnosed with lumbar facet joint pain using controlled diagnostic blocks. The inclusion criteria was based on a positive response to diagnostic controlled comparative local anesthetic lumbar facet joint blocks. The treatment included therapeutic lumbar facet joint nerve blocks. Outcome Measures: The sustained diagnosis of lumbar facet joint pain at the end of one year and 2 years based on pain relief and functional status improvement. Results: At the end of one year 93% of the patients and at the end of 2 years 89.5% of the patients were considered to have lumbar facet joint pain. Limitations: The study is limited by its observational nature. Conclusion: Controlled diagnostic lumbar facet joint nerve blocks are valid utilizing the criteria of 80% pain relief and the ability to perform previously painful movements, with sustained diagnosis of lumbar facet joint pain in at least 89.5% of the patients at the end of a 2-year follow-up period. Key words: Chronic low back pain, lumbar facet or zygapophysial joint pain, facet joint nerve or medial branch blocks, controlled local anesthetic blocks, construct validity, diagnostic studies, diagnostic accuracy

scholarly journals Hysterectomy optimization technology in patients with overweight

2020 ◽  
Vol 3 (13) ◽  
pp. 22-26
Author(s):  
B. Khabrat ◽  
O. Lytvak ◽  
B. Lysenko ◽  
A. Khabrat ◽  
V. Pasko
Keyword(s):  
High Frequency ◽  
Uterine Fibroids ◽  
Control Group ◽  
Proximal Point ◽  
Testing Method ◽  
Inflammatory Processes ◽  
Serious Injury ◽  
One Year ◽  
Stage 1

Aim. The aim of our work was the development and testing method of hysterectomy, which would greatly facilitate radical hysterectomy in patients who are overweight. Materials and methods. In the main group of supervision were included 76 women who had 0 and stage 1 prolapse by POP-Q classification and were operated under minimally invasive surgery of RPCPCM in the period from 2019 to 2020because of uterine fibroids by the method developed by us.The control group consisted of 50 women whom was performed intrafascial hysterectomy by the method of Oldridge. To study the vaginal profile marked by two indicators: the length of the vagina and the range of displacement of the proximal point of the vagina (apex), which were determined before surgery and 24 months after surgery at intervals of one year. Determining the length of the vagina was performed in the supine position, immediately determine the most proximal point of the vagina. Results and discussion Conclusions. Methods of intrafascial hysterectomy using high-frequency diathermy are effective in preventing prolapse stump and shortening of the vagina. Shortening of the vagina in patients in the control group may have been caused by the degenerative processes due to serious injury of support structures and vessels of proximal vagina with the emergence in this context of inflammatory processes in the stump. Shortening of the vagina in patients operated on the proposed method was observed. Trends shortening of the vagina or prolapse at follow-up were found.

scholarly journals Effect of Lumbar Medial Branch Nerve Radiofrequency Ablation on Lumbar Spondylolisthesis

2020 ◽  
Author(s):  
Trusharth Patel ◽  
Christopher Watterson ◽  
Anne Marie McKenzie-Brown ◽  
Boris Spektor ◽  
Katherine Egan ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Degenerative Spondylolisthesis ◽  
Lumbar Pain ◽  
Medial Branch ◽  
Academic Center ◽  
Spine Imaging ◽  
Grade Ii ◽  
The Mean ◽  
Lumbar Spondylolisthesis

AbstractImportanceRadiofrequency ablation (RFA) is a denervation therapy commonly performed for pain of facet etiology. Degenerative spondylolisthesis may be a co-existing condition; yet the effect of RFA on advancing listhesis is unknown.ObjectiveTo test the hypothesis that RFA of painful facets in the setting of spondylolisthesis may contribute to advancement of further degenerative spondylolisthesis.DesignRetrospective and prospective, observational study conducted at a single academic center among 15 participants with pre-existing degenerative Grade I or Grade II spondylolisthesis undergoing lumbar RFA encompassing spondylolisthesis level and followed with post-RFA imaging at 12 months and beyond to measure percent change in spondylolisthesis.Main Outcomes and MeasuresThe primary outcome was the percent advancement of spondylolisthesis per year measured on post-RFA lateral lumbar spine imaging compared to non-intervention baseline advancement of 2.6% per limited observational studies.ResultsAmong the 15 participants enrolled, 14 completed the study (median age 66; 64.3% women; median BMI 33.5; mean follow-up time 23.9 months). The mean advancement of spondylolisthesis per year after RFA was 1.30% (95% CI −0.14 to 2.78%), with 9/14 below 1.25%.Conclusion and RelevanceAmong patients with lumbar pain originating from facets in the setting of degenerative spondylolisthesis who underwent lumbar RFA, the observed advancement of spondylolisthesis is clinically similar to the baseline of 2.6% per year change. The study findings did not find a destabilizing effect of lumbar RFA in advancing spondylolisthesis in this patient population.

scholarly journals Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up

Clinics ◽  
2014 ◽  
Vol 69 (8) ◽  
pp. 529-534 ◽  
Author(s):  
ID Rocha ◽  
AF Cristante ◽  
RM Marcon ◽  
RP Oliveira ◽  
OB Letaif ◽  
...  
Keyword(s):  
Joint Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Lumbar Facet Joint ◽  
Facet Joint Pain ◽  
Lumbar Facet

AN ILIOPSOAS GANGLION MIMICKING FEMORAL HERNIA

2014 ◽  
Vol 17 (03) ◽  
pp. 1472003
Author(s):  
Kuo-Yuan Huang ◽  
Rong-Sen Yang ◽  
Chin-Chiang Hsieh
Keyword(s):  
Magnetic Resonance Imaging ◽  
Femoral Hernia ◽  
Synovial Cyst ◽  
Joint Capsule ◽  
Iliopsoas Muscle ◽  
Resonance Imaging ◽  
Palpable Mass ◽  
Magnetic Resonance Imaging Mri ◽  
One Year

The palpable mass over the groin region include inguinal or femoral hernia, enlarged lymph nodes, aneurysm or pseudoaneurysm, synovial cyst and iliopsoas ganglion. Among these diagnoses, patients with femoral hernia are at risk of bowel obstruction or strangulation; so it should be treated as an emergency. Ultrasound and magnetic resonance imaging (MRI) are helpful for differential diagnosis. We report a case with a large iliopsoas ganglion located around the distal iliopsoas muscle and tendon with pseudopodia extending close to the joint capsule, mimicking femoral hernia clinically. The patient underwent excision and no recurrence was noted at one-year follow-up.

scholarly journals Making Sense of the Accuracy of Diagnostic Lumbar Facet Joint Nerve Blocks: An Assessment of the Implications of 50% Relief, 80% Relief, Single Block, or Controlled Diagnostic Blocks

2010 ◽  
Vol 2;13 (1;2) ◽  
pp. 133-143
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Pain Relief ◽  
Joint Pain ◽  
Facet Joint ◽  
Lumbar Facet Joint ◽  
Nerve Blocks ◽  
Single Block ◽  
Facet Joint Pain ◽  
One Year ◽  
Lumbar Facet

Background: The presence of lumbar facet joint pain has been overwhelmingly supported and the accuracy of controlled diagnostic blocks has been demonstrated in multiple studies and confirmed in systematic reviews. However, controversy surrounds the following related issues: placebo control, the amount of relief (50% versus 80%), single block versus double block, and placebo or comparative control. Study Design: An observational report of an outcome study to establish the diagnostic accuracy of controlled lumbar facet joint nerve blocks. Setting: An interventional pain management practice setting in the United States. Objective: To determine the accuracy of controlled diagnostic blocks in managing lumbar facet joint pain at the end of 2 years, with 2 different criteria (50% or 80% relief) and single block versus double block. Methods: A previous study of 152 patients showed an 89.5% of sustained diagnosis of lumbar facet joint pain at the end of a 2-year follow-up period when the diagnosis was made with double blocks and at least 80% relief. The present evaluation includes comparison of the above results with a study of 110 patients undergoing lumbar facet joint nerve blocks with positive criteria of at least 50% relief and follow-up of 2 years. The inclusion criteria in both studies was based on a positive response to diagnostic controlled comparative local anesthetic lumbar facet joint blocks, with either 50% or 80% relief and the ability to perform previously painful movements. The treatment in both groups included therapeutic lumbar facet joint interventions either with facet joint nerve blocks or radiofrequency neurotomy. Outcome Measures: The sustained diagnosis of lumbar facet joint pain at the end of one year and 2 years based on pain relief and functional status improvement. Results: At the end of one year, the diagnosis was confirmed in 75% of the group with 50% relief, whereas it was 93% in the group with 80% relief. At the end of the 2-year follow-up, the diagnosis of lumbar facet joint pain was sustained in 51% of the patients in the group with 50% relief, whereas it was sustained in 89.5% of the patients with 80% relief. The results differed between 50% relief and 80% relief with prevalence of 61% facet joint pain with dual blocks with 50% relief, and 31% with dual blocks with 80% relief; whereas with only a single block, the prevalence was 73% with 50% relief and 53% in the 80% relief group. Limitations: The study is limited by its observational nature. Conclusion: Controlled diagnostic lumbar facet joint nerve blocks are valid utilizing the criteria of 80% pain relief and the ability to perform previously painful movements, with a sustained diagnosis of lumbar facet joint pain in at least 89.5% of the patients at the end of a 2-year follow-up. In contrast, the diagnosis was sustained in 51% of the patients with 50% relief at the end of 2 years. Thus, inappropriate diagnostic criteria will increase the prevalence of facet joint pain substantially, leading to inappropriate and unnecessary treatment. Key words: Chronic low back pain, lumbar facet or zygapophysial joint pain, facet joint nerve or medial branch blocks, controlled local anesthetic blocks, construct validity, diagnostic studies, diagnostic accuracy

Infrarenal Aortic Endograft Infection: A Single-Center Experience

2018 ◽  
Vol 53 (2) ◽  
pp. 132-138 ◽  
Author(s):  
Carlota Fernandez Prendes ◽  
Mariel Riedemann Wistuba ◽  
Ahmad Amer Zanabili Al-Sibbai ◽  
Jose Antonio Del Castro Madrazo ◽  
Lino Antonio Camblor Santervas ◽  
...  
Keyword(s):  
Case Series ◽  
Lumbar Pain ◽  
Symptom Presentation ◽  
Single Center Experience ◽  
Aortic Repair ◽  
Tertiary Center ◽  
Endovascular Abdominal Aortic Repair ◽  
One Year ◽  
Endograft Infection

Purpose: Endograft infection is an infrequent but one of the most serious and challenging complications after endovascular aortic repair. The aim of this study was to assess the management of this complication in a tertiary center. Case Series: A retrospective analysis of a prospective database was performed including all patients who underwent elective endovascular abdominal aortic repair (EVAR) from 2003 to 2016 in a tertiary center. Seven cases of endograft infection were identified during the follow-up period from a total of 473 (1.48%) EVAR. Most frequent symptoms at presentation were fever (71.4%) and lumbar pain (57.1%). One case developed an early infection, while 6 cases were diagnosed as late infections. Mean time from endograft placement to symptom presentation was 28.3 months (2-91.5 months). Gram-positive cocci were the microorganisms most commonly isolated in blood cultures (66%). Two cases were managed with endograft removal and aortic reconstruction with a cryopreserved allograft, 2 cases with surgical drainage, and 2 cases exclusively with antibiotic therapy. In 1 case, the diagnosis was performed postoperatively based on intraoperative findings associated with positive graft cultures; and graft explantation was performed with “in situ” reconstruction using a Dacron graft. Perioperative mortality was 42.9%. One-year mortality was 57.1%. Mean follow-up was 21.5 months. Conclusion: Endograft explantation is the gold standard of treatment; however, given the overall high morbi–mortality rates of this pathology, a tailored approach should always be offered depending on the patient’s overall condition. Conservative management can be an acceptable option in those patients with short life expectancy and high surgical risk.

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