IonicRF™: a novel step in technology for radiofrequency ablation treatments

Radiofrequency ablation (RFA) has been utilized since the 1970s to treat various painful conditions. The technology has evolved from its initial use to treat lumbar facet mediated pain with monopolar lesioning to now treat a plethora of chronic pain conditions. This article reviews Abbott Corporation's (IL, USA) IonicRF™ generator. The IonicRF generator utilizes an intelligent power algorithm that improves efficiency and reduces procedure time. The generator also carries a wide range of RFA therapies such as monopolar, bipolar, pulsed or pulsed dose radiofrequency. Additionally, the IonicRF RFA generator is compatible with the Simplicity™ RF probe (Abbott) which allows for efficient and effective denervation of the sacroiliac joint.

Deep Learning-Based Correlation Analysis between Spine Surgery Lumbar Facet Joint and Lumbar Disc Herniation Using Magnetic Resonance Images

The research aimed at discussing the analytic function of convolutional neural network (CNN) algorithm-based magnetic resonance images (MRI) in the correlation between lumbar disc herniation (LDH) and angle and irregular variation of joint (IVJ) of lumbar facet-joint (LFJ). First, CNN-based MRI (CNNM) algorithm was constructed, and Markov random field (MRF) and fuzzy C-means (FCM) algorithms were introduced for comparison. Meanwhile, all patients received MRI examination of lumbar, and CNNM algorithm was adopted in MRI images. The results showed that the sensitivity, specificity, accuracy, and precision (98.53%, 93.65%, 99.56%, and 98.74%, respectively) of the CNNM algorithm were all superior to those of MRF algorithm (90.41%, 81.11%, 91.18%, and 91.13%, respectively) and of FCM algorithm (93.14%, 82.86%, 93.23%, and 93.08%, respectively) ( P < 0.05 ). Besides, the lumbar spine angles of L3-L4, L4-L5, and L5-S1 (6.03 ± 1.34°, 7.14 ± 1.18°, and 8.96 ± 3.26°, respectively) in the experimental group was obviously less than those in the control group (6.84 ± 1.15°, 9.85 ± 1.25°, and 17.34 ± 4.79°, respectively) ( P < 0.05 ). In the experimental group, there was irregular mutation of LFJ in 78 cases, while 8 cases suffered from irregular mutation of LFJ in the control group. The proportions of protrusion in L3/4, L4/5, and L5/S1 segments (11 cases, 53 cases, and 14 cases, respectively) was higher than that in the control group (1 case, 5 cases, and 2 cases, respectively) ( P < 0.05 ). In short, the constructed CNNM algorithm had excellent performance in diagnosing lumbar MRI images and had clinical research and promotion value. Moreover, the IVJ of patients with LDH was notably increased, most of the physiological angle of the lumbar spine changed, and facet joint was correlated with the occurrence of LDH.

Upregulation of P2Y12 Inhibits Chondrocyte Apoptosis in Lumbar Osteoarthritis Through PI3K/AKT Signaling Pathway

Lumbar facet osteoarthritis (FJOA) is one of the major causes of severe low back pain and disability worldwide. However, the underlying mechanism of cartilage degeneration in FJOA remains unclear. The purpose of this study was to investigate the expression of P2Y12 in FJOA and its possible role. Changes of chondrocytes in rat facet joints with degenerative changes were observed by HE and ferro red solid green staining. The expression changes of P2Y12, MMP13 and COL2 in FJOA were observed by immunohistochemistry. In vitro, human SW1353 chondrosarcoma cells were stimulated with IL-β to establish chondrocyte apoptosis model. Western blot analysis showed that P2Y12 and cleaved caspase-3 were significantly expressed in SW1353 cells. Co-localization of P2Y12-cleaved Caspase-3 in apoptosis model was detected by double-standard immunofluorescence staining. We demonstrated that P2Y12 may have an anti-apoptotic effect in FJOA chondrocytes apoptosis by inhibiting the expression of P2Y12 by siRNA. In addition, flow cytometry showed that P2Y12 gene knockout enhanced apoptosis induced by P2Y12. Our data suggest that P2Y12 has a chondroprotective effect on FJOA.

Facet Joint Injections for the Management of Low Back Pain: A Clinical Review

Introduction: Lumbar facet joints have been implicated in chronic low back pain (LBP) in up to 45% of patients with LBP. Facet joint pain (FJP) diagnosis and management are always challenging for pain physicians. FJP is not diagnosed by specific demographic features, pain characteristics, or physical findings, despite the electrodiagnostic studies and imaging modalities being available. Although comparative local anesthetics or placebo saline injections can be used, diagnostic blocks are the only reliable diagnostic measures according to the current literature. Methodology: A randomized, controlled clinical trial was conducted to evaluate the effectiveness of lumbar facet joint injections. A total of 229 participants were enrolled to receive facet injections with bupivacaine and steroid, medial branch blocks, or saline. Result: The results of this study showed that facet joint injections had little long-term therapeutic utility, but had a prognostic value compared to control injections before radiofrequency ablation. Thus, the results of this study emphasized the diagnostic value of facet joint injections. Conclusion: FJP is not diagnosed by demographic features, pain characteristics, physical findings, electrodiagnostic studies, or radiological evaluation as other types of LBP. Diagnostic blocks using comparative local anesthetic blocks or placebo injections are the only reliable diagnostic measures according to the current literature. Their validity, specificity, and sensitivity are considered reliable in the diagnosis of FJP. Facet joint-related anatomical, clinical, and technical knowledge is essential for successful pain management. Pain physicians should embrace all aspects of FJP management, from diagnosis to interventional management.