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519 EFFECTIVENESS AND SIDE EFFECTS AFTER PERCUTANEOUS NUCLEOPLASTY
Topic D: TREATMENT APPROACHES (MEDICAL/INTERVENTIONAL) perpendicularly. Because optimal coagulation implies electrode position parallel to the nerves [2], this approach probably produces a minimal lesion. RF denervation should be accomplished by multiple lesions, to account for the location and variability of the target nerves. MRI demonstrated that the great femoral vessels are punctured. An oblique electrode approach could avoid puncture of the femoral nerve-vessel bundle and minimizes the angle between target nerve and electrode, thereby potentially producing a more extensive nerve coagulation. Conclusions: The method that we described has the potential to produce complete and reliable nerve coagulation. It minimizes the risk of penetrating the great vessels. The efficacy of this approach should be tested in clinical trials.
S137 weakness, headaches, nausea/vomiting, bleeding, and needle insertion site soreness. Results: A total of 18 patients enrolled. The most common side effects at 24 hours post procedure was soreness at needle insertion side, new numbness and tingling. At 2 weeks, no patient had soreness at the needle insertion site or new areas of back pain. There were statistically significant reductions in visual analog scale score for back pain and leg pain (p < 0.01). Two patients had no changed intensity of preprocedure back pain. Conclusions: Based on this preliminary data, nucleoplasty seems to be associated with at 24 hours increased pain at the needle insertion site, and respected to obtain satisfactory clinical results, but should also be confirmed by a multicentric based on a large series.
References [1] Kawaguchi et al, Reg Anaesth Pain Med 2001; 26: 576–81. [2] Bogduk N et al, Neurosurgery 1987; 20: 529–35.
518 TREATMENT OF IDIOPATHIC TRIGEMINAL NEURALGIA WITH RADIOFREQUENCY LESIONING: OUR 15-YEAR EXPERIENCE IN 1400 PATIENTS. A PRELIMINARY REPORT S. Erdine ° , N.S. Ozyalcin, G.K. Talu, A. Cimen. Department of Algology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey Background and Aims: When the pharmacological treatment of idiopathic trigeminal neuralgia fails, a choice between a minimally invasive technique and a surgical approach should be made. By far, one of the most common procedures to treat pain, especially in elderly patients, is the use of percutaneous radiofrequency lesioning (RF). We retrospectively analyzed our 15-year data. Methods: A total of 1400 patients who underwent radiofrequency lesioning of trigeminal ganglion for the treatment of unilateral idiopathic trigeminal neuralgia between 1991 and 2005 were retrospectively evaluated. Results: The mean follow-up time was 35.3±24.7 months (range: 12– 180 months). The total number of RF applications was 2228. Out of 1400 patients, 966 (69%) had single RF application whereas 158 (11%) had 2 RF applications and 276 (20%) had 3 or more RF applications. Immediate pain relief was achieved in 1348 patients (96.3%). Pain recurrence was observed in 204 patients (14%) in the first year and in 416 patients (29.7%) in 5 years following the RF application. No mortalities occurred. The complication rates were as follows: Diminished corneal reflex in 102 patients (7.3%), masseter weakness in 68 patients (4.9%), peri-oral herpetic eruption in 48 patients (3.4%), annoying dysesthesia in 28 patients (2%), anesthesia dolorosa in 18 patients (1.3%) and transient paralysis of VIth cranial nerve in 4 patients (0.3%). Conclusions: When pharmacological treatment fails, percutaneous application of RF in the treatment of idiopathic unilateral trigeminal neuralgia is a treatment of choice with high success and low complication rates.
519 EFFECTIVENESS AND SIDE EFFECTS AFTER PERCUTANEOUS NUCLEOPLASTY E. Gurses ° , B. Ulker. Dept of Anesthesiology, Pamukkale University, Medicine Faculty, Denizli, Turkey Background and Aims: The prevalence of low back pain has exploded in recent years. Nucleoplasty, a new minimally invasive procedure, uses radiofrequency energy to remove nucleus material and create small channels within the disc. The purpose of this study was to assess the short-term clinically effectiveness and side effects after percutaneous nucleoplasty. Methods: Following institutional ethic committee approval, included in this series were 18 patients with significant back pain, sitting intolerance, and positive discography who also underwent percutaneous nucleoplasty. Patients were questioned preoperatively, postoperatively, 24 hours, 2 week and 3 month post procedure by an independent reviewer regarding possible symptom complications, which included back and leg pain, bowel and bladder symptoms, muscles spasm, new pain, numbness/tingling or
520 RADIOFREQUENCY LESIONING OF LATERAL BRANCHES AS A TREATMENT FOR SACROILIAC JOINT PAIN: A RETROSPECTIVE STUDY D. Olmez ° , A.H. Ozturk. Regional Pain Management Center/Cabell Huntington Hospital, Huntington, WV, USA Background and Aims: Pain arising from the sacroiliac (SI) joint is a common cause of low back pain. Only a few clinical studies related to radiofrequency (RF) lesioning of lateral branches to the SI joint are found in the literature. The purpose of this study was to evaluate the efficacy of RF lesioning of the nerves innervating the SI joint. Methods: This is a retrospective chart review study of 110 patients involving 130 RF lesioning of L5 dorsal rami, S1-S3 lateral branches of primary dorsal rami. The criteria for RF lesioning was 75% or more pain relief from SI joint injection. Successful outcome for RF lesioning was defined as 50% or more pain relief for a period of at least 3 months. Results: 3 months after the treatment, 7 patients (6%) reported complete pain relief. 83 patients (75.5%) reported 50% or more pain relief. 10 patients (11%) reported no pain relief. No long term complications were noted. Conclusion: RF denervation of the L5 dorsal rami and S1-S3 lateral branches of primary dorsal rami appears to be safe and effective treatment for patients with SI joint pain. References [1] Cohen SP, Abdi S. Lateral branch blocks as a treatment for sacroiliac joint pain: a pilot study. Reg Anesth Pain Med. 2003; 28: 113–119. [2] Yin W, Willard F, Carreiro J, Dreyfuss P. Sensory stimulation-guided sacroiliac joint radiofrequecy neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine. 2003 Oct 15; 28(20): 2419–2425.
521 EFFICACY OF PULSED RADIOFREQUENCY IN THE TREATMENT OF CHRONIC FACET JOINT PAIN I. Tekin1 ° , H. Mirzai2 , G. Ok1 , K. Erbuyun1 , D. Vatansever1 . 1 Department of Anesthesiology, 2 Department of Neurosurgery, Medical School of Celal Bayar University, Manisa, Turkey Background and Aims: The goal of this study is to compare the effects of continuous radiofrequency (CRF) and pulsed RF (PRF) to medial branches of dorsal rami in the treatment of facet pain. Methods: This study was approved by ethical committee. Written informed consent was obtained from all patients. Inclusion: chronic low back pain with or without radiating pain, focal tenderness over the facet joints, pain on hyperextension, unresponsive to conservative treatment, no radicular syndrome. Patients experiencing a positive response to diagnostic medial branch block were included. The electrodes were positioned with fluoroscopic guidance. In CRF group (n = 20), 80ºC, 90 seconds RF were applied, whereas in PRF group (n = 20), 45 V, 42ºC, 4 min. PRF were utilized. Control group (n = 20) received only local anesthetic. Pain was evaluated by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at preprocedure, postprocedure and at 6 months and 1 year.
S137 weakness, headaches, nausea/vomiting, bleeding, and needle insertion site soreness. Results: A total of 18 patients enrolled. The most common side effects at 24 hours post procedure was soreness at needle insertion side, new numbness and tingling. At 2 weeks, no patient had soreness at the needle insertion site or new areas of back pain. There were statistically significant reductions in visual analog scale score for back pain and leg pain (p < 0.01). Two patients had no changed intensity of preprocedure back pain. Conclusions: Based on this preliminary data, nucleoplasty seems to be associated with at 24 hours increased pain at the needle insertion site, and respected to obtain satisfactory clinical results, but should also be confirmed by a multicentric based on a large series.
References [1] Kawaguchi et al, Reg Anaesth Pain Med 2001; 26: 576–81. [2] Bogduk N et al, Neurosurgery 1987; 20: 529–35.
518 TREATMENT OF IDIOPATHIC TRIGEMINAL NEURALGIA WITH RADIOFREQUENCY LESIONING: OUR 15-YEAR EXPERIENCE IN 1400 PATIENTS. A PRELIMINARY REPORT S. Erdine ° , N.S. Ozyalcin, G.K. Talu, A. Cimen. Department of Algology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey Background and Aims: When the pharmacological treatment of idiopathic trigeminal neuralgia fails, a choice between a minimally invasive technique and a surgical approach should be made. By far, one of the most common procedures to treat pain, especially in elderly patients, is the use of percutaneous radiofrequency lesioning (RF). We retrospectively analyzed our 15-year data. Methods: A total of 1400 patients who underwent radiofrequency lesioning of trigeminal ganglion for the treatment of unilateral idiopathic trigeminal neuralgia between 1991 and 2005 were retrospectively evaluated. Results: The mean follow-up time was 35.3±24.7 months (range: 12– 180 months). The total number of RF applications was 2228. Out of 1400 patients, 966 (69%) had single RF application whereas 158 (11%) had 2 RF applications and 276 (20%) had 3 or more RF applications. Immediate pain relief was achieved in 1348 patients (96.3%). Pain recurrence was observed in 204 patients (14%) in the first year and in 416 patients (29.7%) in 5 years following the RF application. No mortalities occurred. The complication rates were as follows: Diminished corneal reflex in 102 patients (7.3%), masseter weakness in 68 patients (4.9%), peri-oral herpetic eruption in 48 patients (3.4%), annoying dysesthesia in 28 patients (2%), anesthesia dolorosa in 18 patients (1.3%) and transient paralysis of VIth cranial nerve in 4 patients (0.3%). Conclusions: When pharmacological treatment fails, percutaneous application of RF in the treatment of idiopathic unilateral trigeminal neuralgia is a treatment of choice with high success and low complication rates.
519 EFFECTIVENESS AND SIDE EFFECTS AFTER PERCUTANEOUS NUCLEOPLASTY E. Gurses ° , B. Ulker. Dept of Anesthesiology, Pamukkale University, Medicine Faculty, Denizli, Turkey Background and Aims: The prevalence of low back pain has exploded in recent years. Nucleoplasty, a new minimally invasive procedure, uses radiofrequency energy to remove nucleus material and create small channels within the disc. The purpose of this study was to assess the short-term clinically effectiveness and side effects after percutaneous nucleoplasty. Methods: Following institutional ethic committee approval, included in this series were 18 patients with significant back pain, sitting intolerance, and positive discography who also underwent percutaneous nucleoplasty. Patients were questioned preoperatively, postoperatively, 24 hours, 2 week and 3 month post procedure by an independent reviewer regarding possible symptom complications, which included back and leg pain, bowel and bladder symptoms, muscles spasm, new pain, numbness/tingling or
520 RADIOFREQUENCY LESIONING OF LATERAL BRANCHES AS A TREATMENT FOR SACROILIAC JOINT PAIN: A RETROSPECTIVE STUDY D. Olmez ° , A.H. Ozturk. Regional Pain Management Center/Cabell Huntington Hospital, Huntington, WV, USA Background and Aims: Pain arising from the sacroiliac (SI) joint is a common cause of low back pain. Only a few clinical studies related to radiofrequency (RF) lesioning of lateral branches to the SI joint are found in the literature. The purpose of this study was to evaluate the efficacy of RF lesioning of the nerves innervating the SI joint. Methods: This is a retrospective chart review study of 110 patients involving 130 RF lesioning of L5 dorsal rami, S1-S3 lateral branches of primary dorsal rami. The criteria for RF lesioning was 75% or more pain relief from SI joint injection. Successful outcome for RF lesioning was defined as 50% or more pain relief for a period of at least 3 months. Results: 3 months after the treatment, 7 patients (6%) reported complete pain relief. 83 patients (75.5%) reported 50% or more pain relief. 10 patients (11%) reported no pain relief. No long term complications were noted. Conclusion: RF denervation of the L5 dorsal rami and S1-S3 lateral branches of primary dorsal rami appears to be safe and effective treatment for patients with SI joint pain. References [1] Cohen SP, Abdi S. Lateral branch blocks as a treatment for sacroiliac joint pain: a pilot study. Reg Anesth Pain Med. 2003; 28: 113–119. [2] Yin W, Willard F, Carreiro J, Dreyfuss P. Sensory stimulation-guided sacroiliac joint radiofrequecy neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine. 2003 Oct 15; 28(20): 2419–2425.
521 EFFICACY OF PULSED RADIOFREQUENCY IN THE TREATMENT OF CHRONIC FACET JOINT PAIN I. Tekin1 ° , H. Mirzai2 , G. Ok1 , K. Erbuyun1 , D. Vatansever1 . 1 Department of Anesthesiology, 2 Department of Neurosurgery, Medical School of Celal Bayar University, Manisa, Turkey Background and Aims: The goal of this study is to compare the effects of continuous radiofrequency (CRF) and pulsed RF (PRF) to medial branches of dorsal rami in the treatment of facet pain. Methods: This study was approved by ethical committee. Written informed consent was obtained from all patients. Inclusion: chronic low back pain with or without radiating pain, focal tenderness over the facet joints, pain on hyperextension, unresponsive to conservative treatment, no radicular syndrome. Patients experiencing a positive response to diagnostic medial branch block were included. The electrodes were positioned with fluoroscopic guidance. In CRF group (n = 20), 80ºC, 90 seconds RF were applied, whereas in PRF group (n = 20), 45 V, 42ºC, 4 min. PRF were utilized. Control group (n = 20) received only local anesthetic. Pain was evaluated by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at preprocedure, postprocedure and at 6 months and 1 year.