Radiofrequency Ablation Using a Novel Multitined Expandable Electrode: Device Description and Research Study1
R.E. Wright, K.J. Allan, M. Kraft, & B.R. Holley. Minimally Invasive Surgery for Pain, Volume 2, Number 1, 41-54, Article published in MISP Journal, 2013
Abstract:
Durable pain remission using radiofrequency thermal neurotomy (RTN) requires thoughtful patient selection and a lesion of optimal size and position. Success necessitates complete ablation of approximately 8-10 mm of the targeted neural pathway. Technical failure may result if anatomic variations in the targeted pathway are not incorporated into the lesion and if the electrode is not positioned optimally relative to the target nerve. This paper presents an improvement in RF electrode design intended to improve RTN outcomes.
Conclusions:
This is the first description of a multitined, expandable electrode designed for use in spinal radiofrequency procedures. It is manufactured by Nimbus Concepts, LLC in Austin, Texas. This novel radiofrequency electrode was developed using dual deployable tines for electrical field diffusion and increased functional electrode surface area. The lesion it produces is geometrically predictable and thermally stable. ¶ The innovative design of the electrode and the resulting geometry and stability of the tissue lesion are uniquely suited to safe, technically efficient, and effective interruption of nociceptive pathways. Detailed anatomical research into afferent pain pathways provided the basis for the electrode design and supports the premise that this device will enable practitioners to consistently achieve appropriate tissue ablation with fewer heat cycles and less global tissue trauma compared to the various monopolar designs currently in use. ¶ The advent of a technologically advanced radio-frequency electrode that produces directional and optimally-sized lesions for neurotomy holds great promise for interventional pain management. The design simplifies technique and readily adapts to various RF ablation targets including the cervical, thoracic and lumbar zygapophyseal joints, the sacroiliac joint, and other targets along the spinal sympathetic chain. Furthermore, the multitinedconstruct has the potential to configure future devices that will shape lesions even more precisely for additional specific thermal ablation targets heretofore not possible with current electrodes.
Comparisons of Lumbar Facet Radiofrequency Neurotomy Using a Conventional Monopolar versus Multitined Electrode2
R. Burnham, MD. Pain Medicine, Volume 16, Number 8, 2015, page 1650-51
Background:
Strategies to expand radiofrequency(RF) lesion size to accommodate medial branch nerve location variability include multiple lesions using a conventional monopolar electrode and the use of a multitined (Nimbus) electrode.
Objective:
To compare the effect of electrode type (conventional monopolar versus multitined) on relief of pain and disability, procedure time and fluoroscopy exposure.
Methods:
25 consecutive patients underwent lumbar facet RF using a single multitined thermal lesion per medical branch nerve. Each had previously undergone successful lumbar facet RF using 2 conventional monopolar lesions over the same medial branch nerves. Prospectively gathered Pain Disability Questionnaire (PDQ) scores were recorded prior to and at 2 months post RF for both groups and at 6 months post RF for the multitined electrode group. RF procedure duration and fluoroscopy times were also recorded. Data were analyzed using Analysis of Variance.
Results:
PDQ scores dropped significantly and comparably at 2 months post RF in both the monopolar and multitined electrode groups {pre:postmean(sd) scores – monopolar 28.8(5.5):11.6(6.1); multitined 28.6(5.6):11.0(6.7)}. The 6 month post RF PDQ score remained significantly improved the multitined group {14.9(7.5)}. Pain scores also dropped significantly and comparably in both groups {pre:post mean(sd) scores – monopolar 6.4(1.8):2.6(1.4); multitined 6.3(1.6:2.3(1.4)}. The 6 month post RF pain score remained significantly improved in the multitined group {3.3(2.1)}. At 2 months post RF, 76% and 72% of the monopolar and multitined groups respectively had experienced 50% or more pain relief. Procedure time was significantly shorter with the multitined electrode {in minutes – monopolar 45 (15.2); multitined 25.5(8.2)}. Fluoroscopy exposure was comparable {in seconds – monopolar 117 (49.8); multitined 98.4(34.4)}.
Conclusions:
Pain and disability relief from lumbar facet radiofrequency neurotomy are significant and comparable whether using a conventional monopolar or multitined electrode. The procedure is significantly quicker when using the multitined electrode. Fluoroscopy exposure is comparable.
An Ex Vivo Study On Radiofrequency Tissue Ablation Using a Novel Multitined Expandable Electrode4
R.E. Wright, S.A. Brandt; Pain Medicine, Volume 12, Number 9, 1446, 2011
Presented at International Spine Intervention Society 19th Annual Meeting in Chicago, Illinois (Best Basic Science Abstract)
Radiofrequency (RF) ablation has been effectively used to interrupt nociception arising from various spinal pain generators1. Anatomic variation in the targeted neural pathways and suboptimal electrode placement may result in technical failure and poor patient outcomes. Intuitively, larger lesions mean a larger tolerance for both errors in electrode placement as well as the inevitable variation in the anatomic position of target nerves2. A novel multitined expandable RF electrode was developed.
Objective:
Investigate the evolution in typography of a thermal lesion produced by a novel RF electrode.
Methods:
Sections of raw muscle tissue were allowed to equilibrate to 37°C in a distilled water bath. RF electrode with tines deployed was positioned to contact tissue surface in 10 trials, and was inserted into tissue in 10 trials. A Radionics RFG 3C RF generator energy source was set at 75°C for 80 seconds. Propagation of tissue coagulation was documented with video and calibrated Flir T-400 thermal camera. Tissue samples were sectioned and coagulation zones measured.
Results:
Infrared observation demonstrated symmetric and homogenous lesion progression without hot spots or focal over-impeding. Calculated volume averaged 467 +/- 71 mm3/lesion. Topography was elongate spheroid offset from the central axis toward tines.
Conclusions:
A novel RF electrode prototype using dual deployable tines for electrical field diffusion reliably produces a lesion potentially useful in spinal applications.
References:
1. Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Efficacy And Validity Of Radiofrequency Neurotomy For Chronic Lumbar Zygaphysial Joint Pain. Spine 2000; 25:1270-7. 2. Lord S, McDonald G, Bogduk N. Percutaneous Radiofrequency Neurotomy of the Cervical Medial Branches: A Validated Treatment for Cervical Zygapophysial Joint Pain. Neurosugery Quarterly 1998; 8(4): 288-308.
This is the first description of a multitined, expandable electrode designed for use in spinal radiofrequency procedures. It is manufactured by Nimbus Concepts, LLC in Austin, Texas. This novel radiofrequency electrode was developed using dual deployable tines for electrical field diffusion and increased functional electrode surface area. The lesion it produces is geometrically predictable and thermally stable.
Technical Efficacy of a Direction Specific Radiofrequency Device in the Performance of Lumbar Medial Branch Neurotomies – An MRI and EMG Confirmation Study (Interim Analysis)5
J.S. Bainbridge, MD, R.E. Wright, MD, C.D. Pappas, MD, S. Light, BA, RC, R.B. McQueen, PhD, Pain Medicine, Volume 16, Number 8, 2015, page 1650
Background/Objective:
Lesion position and geometry are cardinal in maximizing safety and efficacy when performing lumbar medial branch radiofrequency ablation (LMBRFA). Technical efficacy of a multi-tined expandable electrode (MEE), with perpendicular approach, was demonstrated using a novel LMRI validation protocol and corroborated with paraspinous EMG (PEMG) findings in this IRB approved study.
Methods:
Patients (n=6 MRI, n=5 EMG) chosen for LMBRFA underwent pre and post LMRI and PEMG[1]. Post-ablation LMRI using a previously described[2] protocol was obtained 7 days following RFA and used to quantify lesion size and provide lesion topography and anatomic relationship information. Post-LMBRFA EMG was obtained at 3-6 weeks. Monitoring of possible complications was carried out.
Results:
Lesions were achieved, incorporating the target MB/SAP wall, in all cases*. Mean lesion volume was 601.7mm3 (n=40, 95%CI: 522.6, 680.8). No bony edema or complications were noted. EMG evidence of target medial branch ablation was achieved in 88%* (n=34, 95%CI: 77-99) of targets which compares favor- ably with EMG % ablation of Dreyfuss, et al [3] of 90.5%. *One subject underwent repeat procedure, adding one additional MRI/EMG positive ablation site – included in these results. There were no complications.
Comments:
Post-MBRFA LMRI, supported by PEMG, was used to demonstrate technical efficacy and safety of a multi-tined expandable RF electrode, using a new technique (perpendicular approach) that simplifies this ablative procedure for this common target. This validation method is an extension of all ex-vivo RF work done to date, and may be used for future research, as well as being a useful tool for educational purposes.
References:
1) Haig, A.J., et al., Paraspinal mapping: quantified needle electromyography in lumbar radiculopathy. Muscle Nerve, 1993. 16(5): p. 477-84. 2) Wright, R., Bainbridge, JS, Allan, KJ, MRI Protocol for Analysis of Tissue Ablation Following Dorsal SIJ Radiofrequency Denervation, in ISIS ASM July, 2013 Poster Session. 2013. 3) Dreyfuss, P., et al., Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine, 2000. 25(10): p. 1270-7.
In and Ex Vivo Validation of a Novel Technique for Radiofrequency Denervation of the Dorsal Sacroiliac Joint – Including a Case Study6
R.E. Wright, K.J. Allan, J.S. Bainbridge, Regional Anesthesia and Pain Medicine, Volume 38, Number 5, Supplement 1, September-October 2013, E161-E162.
Presented at the 32nd Annual ESRA Congress in Glasgow, United Kingdom, September 4-7, 2013
Purpose:
A technique was developed for radiofrequency (RF) ablation of the L5 dorsal ramus (L5DR) and S1-3 lateral branches (LBs) making use of a novel (FDA approved Nimbus Multi-tined Expandable Electrode) RF electrode.
Materials/Methods:
The typical distance between lateral walls of adjacent S1-3 foramina is 18-22mm. Tissue coagulation in chicken breast using Nimbus electrodes in bipolar configuration with 20mm gap (and in vivo simulation with 37°C water bath) was observed thermographically. A Baylis RF generator produced parameters of 80°C for 120 seconds (30 sec. ramp time). Tissue samples were sectioned and geometric measurements were made at 10mm from either electrode (lesions >10mm in diameter). The experiment was replicated using the palisade bipolar strip lesion method, for comparison of data. Consented adults underwent the Nimbus Continuum strip lesion technique, and MRI assessment was obtained 13 days post-RF. Lesion (edema) size was scored with an axial fat suppressed proton density sequence (echo train 8, TR 3000ms, TE 26ms) and the tubular (diam. 11.7mm) tissue change extended from L5-S1 through S4 segment inclusive, and overlapped the known dorsal sacroiliac join (SIJ) innervation.
Results:
Bench and in vivo findings thus far support the Nimbus Continuum technique as a method for the ablation of the L5DR and S1-3 lateral branches for dorsal SIJ denervation.
Conclusions:
This new RF technique appears to be technically effective and time efficient as a method for successful dorsal SIJ denervation.
MRI Protocol for Analysis of Tissue Ablation Following Dorsal SIJ Radiofrequency Denervation7
R.E. Wright, M.D., J. Weingardt, M.D., J. Scott Bainbridge, M.D., K.J. Allan, M.D
Poster Presentation at the International Spine Intervention Society 21st Annual Meeting in New York, New York, July 2013
Purpose:
The sacroiliac joint (SIJ) is a challenging radiofrequency target owing to variant anatomy of the S1, S2, and S3 lateral branches1. Bipolar RF techniques have been described to expand lesion volume potentially increasing the likelihood of target ablation, currently there is no objective test for evaluating technical success following dorsal SIJ RF denervation. MRI may be useful to correlate the ablation zone with target anatomy. An MRI protocol was developed to quantify volume, and evaluate the spatial characteristics of tissue change pursuant to dorsal SIJ RF denervation.
Materials/Methods:
After consent a 64-year-old male underwent right-sided dorsal SIJ RF denervation. Electrodes (1.45 mm OD) were paired starting at the base of the S1 SAP progressively caudad<progressively 20mm gaps. The Baylis Pain Management generator in bipolar mode delivered an 80°C x150 seconds heat cycle.
Fourteen days post procedure an MRI study was optimized for both spatial and contrast resolution. A sequence sensitive to edema with preserved spatial resolution for accurate volumetric analysis was obtained. Lesion size was scored with an axial fat suppressed proton density sequence (echo train 8, TR 3000ms) at a slice thickness of 5mm with a 1mm gap. A region interest curve was drawn around edematous tissue on each slice providing an area, which was totaled for all of the slices. The total was multiplied by an effective slice thickness of 6mm providing the total volume of edematous tissue.
Results:
Right posterior parasacral edema extended from L5-S1 through S4 segments. Total volume of tissue change was 24.4cm3. The lesion was tubular with average diameter of 11.7mm. Tissue change incorporated described dorsal SIJ innervation.
Conclusions:
An MRI protocol is described which demonstrates RF induced tissue changes following dorsal SIJ denervation.
1. Yin W, et al sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine 2003; 28:2419-25.
Radiofrequency Neurotomy for Sacroiliac Joint Pain: Twelve Month Outcomes and Comparison Between Two Techniques8
R.E. Wright, M.D., DABPM, FIPP, Metro Pain Group, Melbourne, Australia.
Poster Presentation at the 11thAnnual Congress of the European Pain Federation in Valencia, Spain, September 2019
Method:
Retrospective chart review n=182.
Purpose:
The Sacroiliac Joint (SIJ) is an acknowledged pain generator; various descriptions of variable joint innervation inform Radiofrequency ablation (RFA) practices. Many practitioners target S1-S3 lateral branches (LBs) with a “strip lesion” RFA technique while others include the L4 medial branch (MB) and L5 dorsal ramus (DR) in their tactic (1).
Objective:
Ascertain whether RFA of the SIJ results in a durable (twelve month) benefit and determine if including RFA of the L4 MB and L5 DR improved outcomes.
Methods:
One hundred and eighty-two (n=182) patient charts were reviewed. 103 female 79 male average age 52 years. All patients presented with >5/10 on pain VAS index pain below the belt-line and positive Fortin’s finger test. Fluoroscopically guided contrast-confirmed intra-articular injection with >70% relief of index pain and confirmatory multi-site multi-depth lateral branch blocks with >70% relief of index pain was required for RFA. Ninetly-three (93) patients underwent bipolar ablation of S1-S3 lateral branches using a multitined expandable electrode (Nimbus) based on the technique described by Wright et al (2). The author modified his technique and subsequently eighty-nine (89) patients underwent monopolar RFA of the L4 MB and L5 DR in addition to the S1-S3 LB bipolar RFA. Patient’s pain VAS and global PDQQS (3) scores were obtained at baseline, one, six, and twelve months. Only twelve-month data was used to assess “durable” benefit.
Results:
Global baseline pain VAS was 7.2+/- 1.1 and global PDQQ-S score was 79.6 +/- 11.2. At twelve months pain VAS decreased to 2.6 +/- 1.2 and PDQQ-S 35.2 +/- 14.8. (P values <0.001). Subset analysis of the S1-S3 RFA only group showed baseline pain VAS of 7.2 +/- 1.0 and global PDQQ-S of 38.2 +/- 14.2. The group including RFA of L4 MB and L5 DR had baseline pain VAS of 7.1 +/- 1.2 and PDQQ-S of 75.9 +/- 11.5. At twelve months pain decreased to VAS of 2.4 =/- 1 and global PDQQ-S of 32 +/-15.
Conclusion:
RFA of the S1-S3 sacral lateral branches in a well selected population using an anatomically accurate bipolar strip lesion technique producing the necessary and sufficient lesion topography provides highly significant pain reduction and improvement in PDQQ-S at twelve months follow up. Including L4 MB and L5 DR may provide additional benefit and further study is encouraged.
Nimbus: A Novel Multi-Tined Expandable Electrode For Percutaneous Radiofrequency Lesioning Of The Sacroiliac Joint9
A. Al-Kaisy, D. Pang. The British Editorial Society of Bone & Joint Surgery: Orthopaedic Proceedings, Vol. 96-B, No. Supp. 4, February 2018.
Introduction:
Percutaneous radiofrequency lesioning of the lateral branches of the sacroiliac joint has become a recognised method of treating chronic pain arising from this joint. Due to the large and varied innervation from the S1-3 lateral branches success has been achieved with large lesions that has a high chance of covering these nerves. Such lesions require specialised and expensive equipment and the NIMBUS needle is a large 17G electrode with expandable tines at the tip. It is compatible with all standard radiofrequency probes and it produces a large lesion at the tip. It has been in use in the USA in over 100 cases and we describe its use in the UK.
Methods:
Patients were identified as having sacroiliac joint pain by clinical assessment and positive pain response to local anaesthetic sacroiliac joint lateral branch blocks.
Under fluoroscopic control, the needle is inserted at the lateral edge of the sacral S1-3 posterior foramen. Three lesions at the lateral edge of the foramen are made at 80°C for 90s. A further lesion is made at the L5 dorsal ramus.
Results:
4 patients achieved very good pain relief >50% reduction in pain scores on the NRS scale at 6 weeks follow up. No complications were noted and there were no technical difficulties.
Conclusion:
Lesioning with the NIMBUS needle is feasible and allows clinicians a method of treating chronic sacroiliac joint pain using existing radiofrequency equipment. Further large, long term studies are warranted to establish clinical efficacy.
Development and Description of a New Multifidus-Sparing Radiofrequency Neurotomy Technique for Facet Joint Pain10
M.A. Russo, MBBS, DA(UK), FANZCA, FFPMANZCA; D.M. Santarelli, PhD. World Institute of Pain, Vol. 21, Issue 7, September 2021.
Introduction:
The technique of radiofrequency neurotomy (RFN) of the facet joints has been used for decades to treat persistent low back pain to good effect in carefully selected patients. Traditionally, the target is the medial branches of the dorsal root supplying the facet joint. An alternative denervation target is the facet joint capsule. Capsule-targeting techniques may spare the multifidus muscle, a possible unintended target of traditional RFN that is thought to be important in recovering from low back pain, and have shown promising results.
Methods:
A modified RFN technique that targets the capsule and spares the multifidus (multifidus-sparing RFN) is described here, along with a brief report of its application in patients with symptomatic facet joint low back pain as compared to traditional medial branch RFN (MBRF).
Results:
Over a 2-year period, a total of 401 initial multifidus sparing RFN and 94 initial MBRF procedures were performed on patients attending a multidisciplinary pain clinic. The proportion of repeat procedures was similar: 28.4% of multifidus sparing procedures and 23.4% of MBRF procedures. The median repeat interval was 12 months for both groups and interquartile range was 10 months (8–18 months) for multifidus-sparing RFN and 4 months (11–15 months) for MBRF. Effectiveness and safety profiles appear to be similar, although limited, retrospective outcome information prevented robust analysis.
Conclusion:
Multifidus-sparing RFN represents an intriguing technique to denervate the facet joint pain generator while maintaining normal multifidus function. Further study is warranted, particularly in order to identify the appropriate patient criteria and long-term outcomes.
Ultrasound-Guided Radiofrequency Ablation for SI Joint Pain: An Observational Study11
Eldon Lohab, MD, Anne M.Agur, MD, Robert S. Burnham, MD, Interventional Pain Medicine 1 (2022) 100118
Objective:
An ultrasound (US) guided RFA technique for the SIJ, utilizing bipolar RF cannula placements along the lateral sacral crest (LSC), has been proposed in anatomical studies. This study evaluated changes in pain intensity, function and quality of life following this technique.
Methods:
Patients achieving ≥50% pain relief on two blocks (one FL- and one US-guided) were included. US-guided SIJ RFA was performed with sequential bipolar lesions using two multitined RF cannulae placed along the LSC. The Pain, Disability, Quality of Life Questionnaire-Spine (PDQQ-S), which includes an 11-point (0–10) numeric rating scale (NRS) for pain intensity, was completed pre-RFA, and 2, 6, 9, 12 and 16 months post-RFA. Outcomes at 2 months post-RFA were compared between US-guided and FL-guided SIJ RFA in participants with previous FL-guided SIJ RFA.
Results:
31 patients were included. Statistically significant decreases in pain intensity were observed up to 9 months after US-guided SIJ RFA (Baseline NRS: mean = 6.8 SD = 1.6, 95%CI [6.169, 7.347]; 9 month: mean = 4.8, SD = 2.6, 95%CI [3.891, 5.786]; p = 0.0005), and up to 12 months for PDQQ-S. A clinically significant ≥2 point reduction in pain intensity on the NRS was seen in 48.4% of participants at 9 months. 11 participants had previous FL-guided SIJ RFA; no statistically significant differences were found in pain intensity or PDQQ-S scores between US- and FL-guided SIJ RFA 2-months post-RFA.
Conclusion:
Preliminary results suggest that SIJ RFA could be performed using US guidance. Further study is required to establish effectiveness.
Radiofrequency Neurotomy for Sacroiliac Joint Pain: Twelve Month Outcomes and Comparison Between Two Techniques15
R.E. Wright, M.D., DABPM, FIPP & J.E. Block, P.h.D.
Medical Research Archives (2023), [online] 11(12). https://doi.org/10.18103/mra.v 11i12.4978
Background:
Radiofrequency neurotomy (RFN) is an effective treatment option for patients with severe sacroiliac joint (SIJ) pain.
Aims:
We evaluated the 12-month clinical outcomes between patients (n=93) having RFN of the lateral branches of S1-S3 compared to patients (n=89) undergoing the same procedure augmented with RFN of the L4 medial branch and L5 dorsal ramus.
Methods:
This was a retrospective chart review. Following diagnostic intra-articular anesthetic injections and multi-site multi-depth lateral branch nerve blocks to establish SIJ pain, patients underwent bipolar ablation of the S1-S3 lateral branches using the Nimbus multitined electrode. The second group of patients underwent supplementary monopolar RFN of the L4 medial branch and the L5 dorsal ramus. Pain severity and global Pain Disability Quality of Life Questionnaire-Spine (PDQQ-S) scores were obtained prior to RFN and at 12 months.
Results:
There were 61% and 59% average 12-month improvements in SIJ-related pain severity and global PDQQ-S scores, respectively, in the overall study group (P<0.001 for both comparisons). Efficacy was moderately better for patients with augmented ablation that captured the L4 medial branch/L5 dorsal ramus. For example, 12-month average pain reduction was 54% and 66%, and PDQQ-S improvement was 56% and 62% for patients treated with S1-S3 lateral branch RFN and the augmented RFN procedure, respectively. The percentage of patients exhibiting ≥ 50% improvement in pain severity at 12-months was 73% (68 of 93) and 88% (78 of 89) (P=0.016) for the same study groups.
Conclusion:
RFN of the S1-S3 sacral lateral branches using an anatomically accurate bipolar strip lesion technique produced a sufficient lesion topography to provide highly significant pain reduction and improvement in PDQQ-S at 12-months follow-up. Including the L4 medial branch and L5 dorsal ramus in the RFN treatment protocol may offer more complete denervation of all afferent pain pathways and provide additional clinical benefit.
Genicular nerve radiofrequency ablation for the treatment of chronic knee joint pain: a real-world cohort study with evaluation of prognostic factors16
M. Caragea , DO, T. Woodworth, MD, T. Curtis, MD, M. Blatt, BS, C. Cheney, MD, T. Brown, BS, D. Carson , DO, K.T. Kuo, BS, D. Randall, BS, E.Y. Huang, BS, A. Carefoot, MD, M. Teramoto, PhD, MPH, M. Mills, MD, A. Cooper, PhD, T. Burnham , DO, MSCI, A. Conger, DO, Z.L. McCormick, MD
Pain Medicine, 2023, 24, 1332–1340
Background:
Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for chronic knee pain. However, there has been minimal investigation of real-world, long-term outcomes and factors that predict treatment success after GNRFA.
Objectives:
To evaluate the effectiveness of GNRFA for chronic knee pain in a real-world population and identify predictive factors.
Methods:
Consecutive patients who underwent GNRFA at a tertiary academic center were identified. Demographic, clinical, and procedural characteristics were collected from the medical record. Outcome data were numeric rating scale (NRS) pain reduction and Patient Global Impression of Change (PGIC). Data were collected by standardized telephone survey. Predictors of success were evaluated with logistic and Poisson regression analyses.
Results:
Of the 226 total patients identified, 134 (65.6 6 12.7; 59.7% female) were successfully contacted and analyzed, with a mean follow-up time of 23.3 6 11.0 months. Of those, 47.8% (n 1⁄4 64; 95% CI: 39.5%–56.2%) and 61.2% (n 1⁄4 82; 95% CI: 52.7%–69.0%) reported 50% NRS score reduction and 2-point NRS score reduction, respectively, and 59.0% (n 1⁄4 79; 95% CI: 50.5%–66.9%) reported “much improved” on the PGIC questionnaire. Factors associated with a greater likelihood of treatment success (P < .05) were higher Kellgren–Lawrence osteoarthritis grade (2–4 vs 0–1); no baseline opioid, antidepressant, or anxiolytic medication use; and >3 nerves targeted.
Conclusion:
In this real-world cohort, approximately half of the participants experienced clinically meaningful improvements in knee pain after GNRFA at an average follow-up time of nearly 2 years. Factors associated with higher likelihood of treatment success were more advanced osteoarthritis (Kellgren–Lawrence Grade 2–4); no opioid, antidepressant, or anxiolytic medication use; and >3 nerves targeted.
A History of the Development of Radiofrequency Neurotomy12
M. Russo, MBBS, DA(UK), D. Santarelli, R. Wright., and C. Gilligan. Journal of Pain Research, 2021:14.
Abstract:
The technique of lumbar medial branch radiofrequency neurotomy for facet joint pain has an intriguing history involving a diverse timeline of medical specialists. This paper aims to chart the pathway that led to its invention and the series of modifications and refinements that have led to modern practice. The story begins with the treatment of World War I soldiers by Nesfield, who used scalpels to cut “trapped” nerves. Inspired by Nesfield’s treatment, Rees developed the “percutaneous rhizolysis” technique in 1960. Shealy was the first to use radiofrequency electrodes for denervation of the facet joints, introducing his technique in 1971. Several radiofrequency electrode developments came about from colla- borations with Cosman medical device entrepreneurs during the 1970s, including the Shealy Rhizolysis Kit, the Ray Rhizotomy Electrode, and the Sluijter-Mehta Kit. Subsequent dissections of Rees’ technique and modification of Shealy’s procedure by Bogduk saw the development of “percutaneous lumbar medial branch neurotomy” in 1980 by Bogduk and Long. Bogduk continued to contribute significantly to validation, refinement and acceptance of the technique. In 1998, the technique of pulsed radiofrequency was invented by Sluijter, Cosman, Rittman and van Kleef. Subsequent innovations have consisted of cooled radio- frequency neurotomy, multi-tined cannulae, endoscopic systems, and alternative denervation targets, such as the facet joint capsule. As we pass the first 100 years of the story, we believe there are more chapters to be written on this fascinating subject.
Introduction:
Radiofrequency neurotomy (RFN) of the lumbar medial branch for facet joint proven low back pain (via validated medial branch block paradigms) is an estab- lished treatment that has continued since its invention in the early 1970s. Whilst modern descriptions of the technique and its results abound,1–3 there is little collated information on the historical path of invention and refinement of technique that has led to modern practice. This paper aims to chart the circuitous pathway taken and to inform the reader of how inspiration, anecdotal claims, serendipity, and finally scientific rigor has shaped the treatment we know and use today. This paper is not a discursive review of the tenets of the modern technique and the reader is referred to the relevant papers that address that.
History:
Prior to 1934, the year in which Mixter and Barr published on the slipped disc, low back pain was considered some form of inflammatory condition, going under the rubric of lumbago and other descriptors. Treatment was varied, eclectic, and essentially unsuccessful. The natural history of the condition played out with various therapies applied.
Conclusion:
The history of RFN has been a long and winding one. Having started with an eccentric ophthalmologist, followed by an iconoclastic urological surgeon influenced by the inventor of prolotherapy, the story moves to a most remarkable and productive neurosurgeon who teams with a medical device entrepreneur to produce what is recognizable today as the existing therapy. It was validated by an Australian anatomist and then significantly expanded by the enquiring mind of a Dutch anaesthesiologist. Along the way, it has survived the slings of poor practice reports and the arrows of poorly designed trials to remain one of the bedrock foundational techniques of interventional pain medicine. As we pass the first 100 years of the story, we believe there are more chapters to be written on this fascinating subject.
Comparisons of Lesion Volumes and Shapes Produced by a Radiofrequency System with a Cooled, a Protruding, or a Monopolar Probe3
D.L. Cedeño, A. Vallejo, Courtney A.K., D.M. Tilley, and N. Kumar, Millennium Pain Center, Bloomington, Illinois; Illinois Wesleyan University, Bloomington, Illinois; University of Illinois at Urbana-Champaign, Champaign, Illinois, Illinois; Pain Physician: September/October 2017: 20:E915-E922
Consensus Practice Guidelines on Interventions for Lumbar Facet Joint Pain from a Multispecialty, International Working Group13
S.P. Cohen , A. Bhaskar, A. Bhatia, A. Buvanendran, T. Deer, S. Garg, W.M. Hooten , R.W. Hurley, D.J. Kennedy, B.C. McLean, J. Y. Moon, Samer Narouze, S. Pangarkar, D.A. Provenzano, R. Rauck, B.T. Sitzman, M. Smuck, J. van Zundert, K. Vorenkamp, M.S. Wallace, Z. Zhao; Reg Anesth Pain Med 2020;45:424–467. doi:10.1136/rapm-2019-101243
Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN)14
D.W. Lee, S. Pritzlaff, M.J. Jung, P. Ghosh, J.M. Hagedorn, J. Tate, K. Scarfo, N. Strand, K. Chakravarthy, D. Sayed, T.R. Deer, K. Amirdelfan; Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA; University of California, Davis; Division of Pain Medicine, Sacramento, CA, USA; ReMedy Medical Group, San Francisco, CA, USA; Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA; Alliance Spine and Pain Centers, Canton, GA, USA; Warren Alpert Medical School of Brown University Department of Neurosurgery – Norman Prince Spine Institute, Rhode Island Hospital, Providence, RI, USA; Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA; University of California, San Diego; Division of Pain Medicine, San Diego, CA, USA; University of Kansas Medical Center, Kansas City, KS, USA; The Spine and Nerve Center of the Virginias, Inc., Charleston, WV, USA; IPM Medical Group, Inc., Walnut Creek, CA, USA; September 2021: Journal of Pain Research 2021:14 2807–2831