Affiliation:
1. Neuromuscular and Rehabilitation Associates of Northern Michigan, Traverse City, MI.
Abstract
Radiofrequency ablation (RFA) is a safe and effective pain therapy used to create sensory
dysfunction in appropriate nerves via thermal damage. While commonly viewed as a simple
process, RF heating is actually quite complex from an electrical engineering standpoint,
and it is difficult for the non-electrical engineer to achieve a thorough understanding of
the events that occur. RFA is highly influenced by the configuration and properties of the
peri-electrode tissues. To rationally discuss the science of RFA requires that examples be
procedure-specific, and lumbar RFA is the procedure selected for this review. Adequate
heating of the lumbar medial branch has many potential failure points, and the underlying
science is discussed with recommendations to reduce the frequency of failure in heating
target tissues. Important technical details of the procedure that are not generally appreciated
are discussed, and the status quo is challenged on several aspects of accepted technique. The
rationale underlying electrode placement and the limitations of RF heating are, for the most
part, commonly misunderstood, and there may even need to be significant changes in how
lumbar radiofrequency rhizotomy (RFR) is performed. A new paradigm for heating target
tissue may be of value. Foremost in developing best practices for this procedure is avoiding
pitfalls. Good RF heating and medial branch lesioning are the rewards for understanding how
the process functions, attention to detail, and meticulous attention to electrode positioning.
Key words: Electrical equipment and supplies, zygapophyseal joint, catheter ablation,
lumbar vertebrae, low back pain, lumbar vertebrae/innervation, radiofrequency ablation,
water-cooled radiofrequency ablation, conventional radiofrequency ablation, radiofrequency
electrode behavior
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
29 articles.
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