Bipolar Radiofrequency Neurotomy to Treat
Neck and Back Pain in Patients with Automatic
Implantable Cardioverter Defibrillator

We report 2 cases of successful treatment of neck and back pain with bipolar radiofrequency ablation (RFA) of the cervical and lumbar facet joints in patients with an automatic implantable cardioverter defibrillator (AICD). Two patients with complex cardiac histories and AICD devices were treated with bipolar RFA of the facet joints. One presented with axial neck pain and the other with axial back pain. The histories and physical examinations were consistent with facetogenic pain. Diagnostic medial branch block resulted in more than 70% pain relief lasting for several days, allowing patients to perform routine daily activities without significant pain. However, we were concerned about the use of conventional RFA of the medial branches of nerves for the fear of interference with the function of AICD by the RF currents and energy. We took advantage of the localized and limited current of bipolar RFA to perform this procedure for the cervical or lumbar facet joints avoiding any interference with the function of AICD. The procedures provided long-term pain relief to the patients, and marked improvement in their functional status without any evident complications related to the function of their AICD. This case report describes the safe and successful completion of bipolar RFA of the medial branch nerves to treat cervical and lumbar facetogenic pain in patients with AICD. This modality of treatment may be considered in patients with AICD. We are finding it to be increasingly common that patients who present with chronic neck and back pain have AICDs in place. Key words: Back pain, neck pain, facet, AICD, radiofrequency neurotomy, bipolar lesioning

Download Full-text

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

British Journal of Pain ◽

10.1177/2049463719840053 ◽

2019 ◽

Vol 14 (1) ◽

pp. 47-56 ◽

Cited By ~ 1

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.

Download Full-text

Open Endoscopic Rhizotomy

10.1093/med/9780190626761.003.0015 ◽

2018 ◽

Author(s):

Raj J. Gala ◽

Lauren Szolomayer ◽

James Yue

Keyword(s):

Back Pain ◽

Medial Branch ◽

Facet Joints ◽

Endoscopic Techniques ◽

Pathologic Anatomy ◽

Provide Pain Relief ◽

Dorsal Rami ◽

Lumbar Facet ◽

Lumbar Facet Joints

The etiology of axial low back pain is multifactorial and includes pain arising from lumbar facet joints. The facet joints, capsules, and surrounding tissues are innervated by the medial branches of the dorsal rami. Rhizotomy of these nerves can provide pain relief in patients with lumbar facetogenic pain. The reported benefits of endoscopic approaches to the spine include minimal disruption of nonpathologic anatomy while simultaneously allowing for improved visualization of pathologic anatomy. Endoscopic techniques have been described for spinal stenosis, disc herniation, interbody fusion, infection, as well as dorsal medial branch rhizotomy. The goal of medial branch rhizotomy is to denervate lumbar facet joints that are contributing to axial back pain. The previous chapter focused on percutaneous techniques, while this chapter will describe endoscopic rhizotomy.

Download Full-text

Sonoanatomic indices of lumbar facet joints in patients with facetogenic back pain in comparison to healthy subjects

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2016.10.005 ◽

2017 ◽

Vol 36 ◽

pp. 67-71 ◽

Cited By ~ 3

Author(s):

Poupak Rahimzadeh ◽

Hamid Reza Faiz ◽

Ali Reza Baghaee ◽

Nader D. Nader

Keyword(s):

Back Pain ◽

Healthy Subjects ◽

Facet Joints ◽

Lumbar Facet ◽

Lumbar Facet Joints

Download Full-text

An Update of Evaluation of Therapeutic Thoracic Facet Joint Interventions

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/e463 ◽

2012 ◽

Vol 4;15 (4;8) ◽

pp. E463-E481

Author(s):

Frank J.E. Falco

Keyword(s):

Systematic Review ◽

Back Pain ◽

Quality Assessment ◽

Joint Pain ◽

Facet Joint ◽

Medial Branch ◽

Facet Joints ◽

Nerve Blocks ◽

Radiofrequency Neurotomy ◽

Facet Joint Interventions

Background: Chronic mid back and upper back pain caused by thoracic facet joints has been reported in 34% to 48% of patients based on responses to controlled diagnostic blocks. Systematic reviews have established moderate evidence for controlled comparative local anesthetic blocks of thoracic facet joints in the diagnosis of mid back and upper back pain, moderate evidence for therapeutic thoracic medial branch blocks, and limited evidence for radiofrequency neurotomy of thoracic medial branches. Study Design: Systematic review of therapeutic thoracic facet joint interventions. Objective: To determine the clinical utility of therapeutic thoracic facet joint interventions in the therapeutic management of chronic upper back and mid back pain. Methods: The available literature for the utility of facet joint interventions in the therapeutic management of thoracic facet joint pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited (or poor) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to March 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this systematic review, 13 studies were identified. Of these, 7 studies were excluded, and a total of 4 studies (after removal of duplicate publication) met inclusion criteria for methodological quality assessment with one randomized trial and 3 non-randomized studies. The evidence is fair for therapeutic thoracic facet joint nerve blocks, limited for thoracic radiofrequency neurotomy, and not available for thoracic intraarticular injections. Limitations: The limitation of this systematic review includes a paucity of literature. The only positive studies were of medial branch blocks performed by the same group of authors. Conclusion: The evidence for therapeutic facet joint interventions is fair for medial branch blocks, whereas it is not available for intraarticular injections, and limited for radiofrequency neurotomy due to lack of literature. Key words: Chronic thoracic pain, mid back or upper back pain, thoracic facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, therapeutic thoracic medial branch blocks, thoracic radiofrequency neurotomy, thoracic intraarticular facet joint injections

Download Full-text

Association between clinical signs assessed by manual segmental examination and findings of the lumbar facet joints on magnetic resonance scans in subjects with and without current low back pain: A prospective, single-blind study☆

Pain ◽

10.1016/j.pain.2013.06.018 ◽

2013 ◽

Vol 154 (9) ◽

pp. 1886-1895 ◽

Cited By ~ 11

Author(s):

Tina Mainka ◽

Stefan P. Lemburg ◽

Christoph M. Heyer ◽

Jörn Altenscheidt ◽

Volkmar Nicolas ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Magnetic Resonance ◽

Clinical Signs ◽

Blind Study ◽

Low Back ◽

Facet Joints ◽

Lumbar Facet ◽

Single Blind ◽

Lumbar Facet Joints

Download Full-text

Medial Branch Blocks Versus Pericapsular Blocks in Selecting Patients for Percutaneous Cryodenervation of Lumbar Facet Joints

Regional Anesthesia and Pain Medicine ◽

10.1097/00115550-200701000-00006 ◽

2007 ◽

Vol 32 (1) ◽

pp. 27-33 ◽

Cited By ~ 23

Author(s):

Christof Birkenmaier ◽

Andreas Veihelmann ◽

Hans-Heinrich Trouillier ◽

Jörg Hausdorf ◽

Christoph von Schulze Pellengahr

Keyword(s):

Medial Branch ◽

Facet Joints ◽

Lumbar Facet ◽

Lumbar Facet Joints

Download Full-text

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

Pain Management Case Reports ◽

10.36076/pmcr.2020/4/175 ◽

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

Download Full-text