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Comment on ‘Ischaemic spinal cord lesion following percutaneous radiofrequency spinal rhizotomy’ by H.M. Koning, H.G. Koster and R.P.E. Niemeijer in PAIN, 45 (1991) 161–166
Pain, 47 (1991) 241
241
©1991 Elsevier Science Publishers B.V. All rights reserved 0304-3959/91/$03.50
PAIN 01954
Letters to the Editor Comment on 'Ischaemic spinal cord lesion following percutaneous radioffequency spinal rhizotomy' by H.M. Koning, H.G. Koster and R.P.E. Niemeijer in PAIN, 45 (1991) 161-166 M.E. Sluyter, W.A.A.M. Dingemans, G.A.M. Barendse and M. Van Kleef Department of Anesthesiology and Pain Control, Academic Hospital Maastricht, Maastricht (The Netherlands) (Received 13 June 1991, accepted 3 July 1991)
Dear Editor, We would like to comment on the article by Dr. Koning et al. in which he describes two complications following a percutaneous radiofrequency rhizotomy [1]. Firstly, we object to the use of this type of treatment in these particular patients. Since postherpetic neuralgia is a deafferentation type of pain, we feel that R F lesions are contra-indicated in its treatment. The authors justify their choice of treatment by referring to an article by Pagura [2]. This article describes the results of percutaneous R F rhizotomies in 50 patients. Four out of those 50 patients had a postherpetic neuralgia. The result of treatment in those 4 patients is not separately mentioned. We conclude that this article does not offer a single argument for the use of RF lesions in the treatment of postherpetic neuralgia. Secondly, several technical questions remain obscure after reading the article. Radiological documentation of the position of the electrode is unfortunately missing. It is true that the ideal position is in the midfacetal line on the A-P projection and posteriorly in the foramen on the transverse projection. Extensive experience with this procedure has taught us that it is generally impossible to reach this position from a posterolateral approach in the superior thoracic region down to T5. Since the electrode cannot be inserted more laterally than the angle of the ribs, the approach to the foramen is necessarily so steep that the electrode invariably ends up either too far lateral or too far anterior. It is hardly conceivable that no technical difficulty has been encountered during the insertion of the electrode. This does not explain the complication which was de-
Correspondence to." Prof. Dr. M.E. Sluyter, Dept. Anesthesiologie en Pijnbestrijding, Academisch Ziekenhuis Maastricht, P. Debyelaan 25, P.O. Box 5800, 6202 A Z Maastricht, The Netherlands. Tel.: 31-43-876543. Fax.: 31-43-875457,
scribed but we feel that simple, straightforward techniques generally do contribute to the avoidance of complications. Therefore we prefer a technique in which a small hole is drilled with a thin Kirschner wire through the lamina if a radiofrequency rhizotomy has to be performed in the upper thoracic area. It is a simple technique which is painless to the patient. It provides an ideal electrode position. Finally, we object to a rather loose use of references. The author states that an R F lesion with a fine thermocouple electrode is simple and safe. We do agree with that contention but the author then refers to an article by Uematsu et al. [3]. It is interesting to note that Uematsu - who was the first author to describe this procedure used a thermistor electrode which was introduced through a 14-G needle. This technique was followed by other investigators, which inevitably led to complications such as deafferentation syndromes. This has discredited the procedure by Uematsu for a number of years.
References 1 Koning, H.M., Koster, H.G. and Niemeyer, R.P.E., Ischaemic spinal cord lesion following percutaneous radiofrequency spinal rhizotomy, Pain, 45 (1991) 161-166. 2 Pagura, J.R., Percutaneous radiofrequency spinal rhizotomy, Appl. Neurophysiol., 46 (1983) 138-146. 3 Uematsu, S., Advarhelyi, G.B., Parson, P.W. and Siebens, A.A., Percutaneous radiofrequency rhizotomy, Surg. Neurol., 2 (1974) 319-325.
241
©1991 Elsevier Science Publishers B.V. All rights reserved 0304-3959/91/$03.50
PAIN 01954
Letters to the Editor Comment on 'Ischaemic spinal cord lesion following percutaneous radioffequency spinal rhizotomy' by H.M. Koning, H.G. Koster and R.P.E. Niemeijer in PAIN, 45 (1991) 161-166 M.E. Sluyter, W.A.A.M. Dingemans, G.A.M. Barendse and M. Van Kleef Department of Anesthesiology and Pain Control, Academic Hospital Maastricht, Maastricht (The Netherlands) (Received 13 June 1991, accepted 3 July 1991)
Dear Editor, We would like to comment on the article by Dr. Koning et al. in which he describes two complications following a percutaneous radiofrequency rhizotomy [1]. Firstly, we object to the use of this type of treatment in these particular patients. Since postherpetic neuralgia is a deafferentation type of pain, we feel that R F lesions are contra-indicated in its treatment. The authors justify their choice of treatment by referring to an article by Pagura [2]. This article describes the results of percutaneous R F rhizotomies in 50 patients. Four out of those 50 patients had a postherpetic neuralgia. The result of treatment in those 4 patients is not separately mentioned. We conclude that this article does not offer a single argument for the use of RF lesions in the treatment of postherpetic neuralgia. Secondly, several technical questions remain obscure after reading the article. Radiological documentation of the position of the electrode is unfortunately missing. It is true that the ideal position is in the midfacetal line on the A-P projection and posteriorly in the foramen on the transverse projection. Extensive experience with this procedure has taught us that it is generally impossible to reach this position from a posterolateral approach in the superior thoracic region down to T5. Since the electrode cannot be inserted more laterally than the angle of the ribs, the approach to the foramen is necessarily so steep that the electrode invariably ends up either too far lateral or too far anterior. It is hardly conceivable that no technical difficulty has been encountered during the insertion of the electrode. This does not explain the complication which was de-
Correspondence to." Prof. Dr. M.E. Sluyter, Dept. Anesthesiologie en Pijnbestrijding, Academisch Ziekenhuis Maastricht, P. Debyelaan 25, P.O. Box 5800, 6202 A Z Maastricht, The Netherlands. Tel.: 31-43-876543. Fax.: 31-43-875457,
scribed but we feel that simple, straightforward techniques generally do contribute to the avoidance of complications. Therefore we prefer a technique in which a small hole is drilled with a thin Kirschner wire through the lamina if a radiofrequency rhizotomy has to be performed in the upper thoracic area. It is a simple technique which is painless to the patient. It provides an ideal electrode position. Finally, we object to a rather loose use of references. The author states that an R F lesion with a fine thermocouple electrode is simple and safe. We do agree with that contention but the author then refers to an article by Uematsu et al. [3]. It is interesting to note that Uematsu - who was the first author to describe this procedure used a thermistor electrode which was introduced through a 14-G needle. This technique was followed by other investigators, which inevitably led to complications such as deafferentation syndromes. This has discredited the procedure by Uematsu for a number of years.
References 1 Koning, H.M., Koster, H.G. and Niemeyer, R.P.E., Ischaemic spinal cord lesion following percutaneous radiofrequency spinal rhizotomy, Pain, 45 (1991) 161-166. 2 Pagura, J.R., Percutaneous radiofrequency spinal rhizotomy, Appl. Neurophysiol., 46 (1983) 138-146. 3 Uematsu, S., Advarhelyi, G.B., Parson, P.W. and Siebens, A.A., Percutaneous radiofrequency rhizotomy, Surg. Neurol., 2 (1974) 319-325.