New Hope For Spinal Stenosis, Spondylolithesis and Disc Herniation -Pulse Radiofrequency Epidurally

Putting a probe up epidural canal, pulse radiofrequency for 240-360 seconds, and then withdraw catheter can give 50%+ VAS pain drop lasting 1- 3 months. It may stand as an alternative to Steroids or Midazolam epidurally.

Gulduren Aydın LG, et al. Investigation of Effectiveness of Pulsed Radiofrequency With Multifunctional Epidural Electrode for Low Back Pain.
Cureus. 2021;13(12):e20239.
doi:10.7759/cureus.20239
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8734956/

  • 93 Lumbar Disc Herniation; 47 Spinal Stenosis; 19 Spondylolithesis with Spinal Stenosis
  • “Patients are placed in the prone position and a neutral electrode is located on the appropriate site. The intervention site is sterilized with antiseptic solution and covered. Sterile conditions are maintained during the procedure. Sacral hiatus is identified, and 3 ml of 2% prilocaine solution is applied to the subcutaneous and deep tissues as the local anaesthetic. Epidural space is accessed using a 14-gauge introducer cannula. Radiopaque material is injected through the cannula and its location is confirmed with fluoroscopy. The multifunctional electrode is advanced through the cannula and placed at the targeted spinal level, dorsal column of medulla spinals or cauda equina nerves, according to MRI, in the craniolateral direction. Its location is checked with anteroposterior, oblique and lateral fluoroscopic images. The proximal end of the catheter is attached to the radiofrequency generator in a sterile way. After observing proper placement, stimulation is applied at 0.8 V, 50 HZ sensory stim, and the location of the catheter is confirmed when patients feel a stimulation in their symptom area; the point of application is determined. PRF is applied at 42 °C for 240-360 seconds with an active phase of 20 milliseconds and a silent period of 480 milliseconds. After the application, the catheter is withdrawn.”
  • 27.6% had prior back surgery; 24 patients (15.8%) underwent surgery after treatment
  • Procedure done initially, 1 month , 3 months, and 6 months

Results:

They noticed improvement in straight leg raise as well; Flexion improved more so in those without prior surgery

No complications

Comment – done caudally and confirmed with dye. Need Specialist trained in this area but sounds exciting. Spondylothesis instability with spinal stenosis has always scared me but this shows real promise there.

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