Analgesic effects of a capacitive-resistive monopolar radiofrequency in patients with myofascial chronic neck pain: a pilot randomized controlled trial

SUMMARY BACKGROUND: To date, there is a lack of prior studies on the use of capacitive resistive monopolar radiofrequency (RF) to treat neck pain. The objective of this study was to investigate the immediate effect of capacitive resistive monopolar radiofrequency (RF=448 kHz), in comparison with a placebo, on (1) reducing neck pain intensity at myofascial trigger points (MTrP), (2) decreasing neck disability and (3) improving cervical range of motion (CROM). METHODS: A randomized, double-blind, placebo-controlled trial (NCT02353195) was carried out. Patients with myofascial chronic neck pain (N=24) with active MTrP in one upper trapezius muscle were randomly divided into two groups: a radio-frequency group, which received eight sessions of a monopolar capacitive resistive radio-frequency application over the upper trapezius muscle, and a placebo group (PG), which received eight sessions of placebo radio-frequency over the same muscle. Visual analog scale (VAS), CROM and Neck Disability Index (NDI) were evaluated after the first session and after the eight sessions. RESULTS: The Wilcoxon test for VAS showed statistically significant differences between baseline, immediately after the first session and after eight sessions (p<.001). No significant differences for PG were found. No differences were observed between groups. NDI improved in both groups after eight sessions, but no differences were found between groups (p<.05). ANOVA for time factor showed statistically significant changes in the right cervical rotation in both groups (F=4.112; p=.026) after eight sessions. CONCLUSIONS: Even though there were no differences between both groups, the monopolar capacitive, resistive RF could have a potential effect on pain intensity.

RESUMO ANTECEDENTES: Até a data, há uma falta de estudos prévios para tratar a dor no pescoço por radiofrequência (RF) monopolar capacitiva resistiva. O objetivo deste estudo foi investigar o efeito imediato da radiofrequência monopolar capacitiva resistiva (RF = 448 kHz) versus placebo em (1) redução da intensidade da dor no pescoço em pontos de gatilho miofascial (MTrP), (2) diminuição da incapacidade do pescoço e (3) melhorando a amplitude de movimento cervical (Crom). MÉTODOS: Foi realizado um ensaio randomizado, duplo-cego, controlado por placebo (NCT02353195). Os pacientes com dor no pescoço crônica miofascial (N = 24) com MTrP ativo em um músculo trapézio superior foram divididos aleatoriamente em dois grupos: um grupo de radiofrequência, que recebeu oito sessões com uma aplicação de radiofrequência resistiva capacitiva monopolar sobre o músculo trapézio superior, e um grupo de placebo (PG), que recebeu oito sessões de radiofrequência de placebo no mesmo músculo. A escala analógica visual (VAS), Crom e Índice de incapacidade do pescoço (NDI) foram avaliadas após a primeira sessão e após as oito sessões. RESULTADOS: O teste de Wilcoxon para VAS mostrou diferenças estatisticamente significativas entre a linha de base e imediatamente após a primeira sessão e após oito sessões (p < 0,001). Não foram encontradas diferenças significativas para PG. Não foram observadas diferenças entre os grupos. O NDI melhorou em ambos os grupos após oito sessões, mas não foram encontradas diferenças entre os grupos (p < 0,05). A Anova para o fator de tempo mostrou mudanças estatisticamente significativas na rotação direita cervical em ambos os grupos (F = 4,12; p = 0,26) após oito sessões. CONCLUSÕES: Apesar de não haver diferenças entre os dois grupos, o RF resistivo capacitivo monopolar pode ter um efeito potencial sobre a intensidade da dor.

The effect of needle tip position on the analgesic efficacy of pulsed radiofrequency treatment in patients with chronic lumbar radicular pain: a retrospective observational study

BACKGROUND: Pulsed radiofrequency (PRF) is a treatment modality that alleviates radicular pain by intermittently applying high-frequency currents adjacent to the dorsal root ganglion. There has been no comparative study on analgesic effect according to the position of the needle tip in PRF treatment. The objective of this study is to evaluate the clinical outcomes of PRF according to the needle tip position. METHODS: Patients were classified into 2 groups (group IP [group inside of pedicle] and group OP [group outside of pedicle]) based on needle tip position in the anteroposterior view of fluoroscopy. In the anteroposterior view, the needle tip was advanced medially further than the lateral aspect of the corresponding pedicle in group IP; however, in group OP, the needle tip was not advanced. The treatment outcomes and pain scores were evaluated at 4, 8, and 12 weeks after applying PRF. RESULTS: At 4, 8, and 12 weeks, there were no significant differences between the successful response rate and numerical rating scale score ratio. CONCLUSIONS: The analgesic efficacy of PRF treatment did not differ with the needle tip position.

Radiofrecuencia pulsada para tratamiento de neuralgia de nervio pudendo bajo guía ultrasonográfica: a propósito de dos casos / Radiofrequency pulsed for treatment of neuralgia of nervio pudendo under ultrasonographic guide: a purpose of two cases

INTRODUCCIÓN: La neuralgia de nervio pudendo (NNP) se presenta como un dolor neuropático intenso, ardiente y difuso en la zona perineal, acompañado en ocasiones de hipoestesia, alodinia, hiperalgesia, sensibilidad dérmica, parestesia y entumecimiento que empeora el dolor en sedestación. Es un síndrome subdiagnosticado que, en ocasiones, se presenta refractario al tratamiento farmacológico y fisiátrico. OBJETIVOS: Evaluar la eficacia de la radiofrecuencia pulsada (RFP) guiada por ultrasonido para el tratamiento de dolor crónico, realizada a dos pacientes con NNP refractarios a tratamiento conservador. MATERIALES Y MÉTODO: Siendo positivo el bloqueo diagnóstico realizado con 0,5-1 ml de lidocaína al 2 por ciento, se practicó RFP bajo guía ecográfica a 2 pacientes (1 femenina de 36 años y 1 masculino de 54 años) con diagnóstico de NNP (según criterio de Nantes) y se realizó seguimiento a 1 semana y a 1 mes del procedimiento, observando la evolución del dolor mediante la utilización de la escala visual análoga (EVA), calidad de vida según lo informado en consulta y evolución en la ingesta y dosis de medicamentos. RESULTADOS: Luego del procedimiento la reducción del dolor fue significativa en ambos casos, en la paciente 1 (femenina) la EVA pasó de 10/10 (preoperatorio) a 1/10 a una semana del procedimiento y desapareció por completo al mes, retirándose en su totalidad la medicación indicada para la NNP. Asimismo, la paciente manifestó mejora en la calidad de vida, al no tener ya dolor durante el coito. Por su parte, en el paciente 2 (masculino), el dolor se redujo en un 50 por ciento registrándose un EVA que pasó de 8/10 (preoperatorio) a 4/10 a la semana y al mes de realizado el procedimiento. En su caso, al no haber desaparecido por completo el dolor, continuó tomando la medicación indicada (duloxetina 30 mg) y refirió poder sentarse con comodidad, ya sin el dolor intenso que lo aquejaba en esta posición, pudiendo incluso realizar un viaje de larga distancia. DISCUSIÓN: La RFP es un procedimiento efectivo en aquellos pacientes correctamente diagnosticados de neuralgia del nervio pudendo según el criterio de Nantes, refractarios a tratamiento farmacológico y/o fisioterápico, practicada por profesionales con entrenamiento y/o experiencia en la técnica de radiofrecuencia pulsada así como en el manejo de ultrasonido para ubicar sonoanatómicamente el nervio pudendo, en un ámbito seguro para la realización del procedimiento.

INTRODUCTION: The pudendal neuralgia is presented as a neurophatic pain that is intense, burning, difusse in the perineal area, sometimes accompanied by hypoesthesia, allodynia, hyperalgesia, dermal sensitivity, paresthesia and numbness that worsens by sitting. It ́s a syndrome underdiagnosed that can sometimes be refractory to traditional management like pharmacological or physical therapy. OBJECTIVES: Test the effectiveness of pulsed radiofrecuency by ultrasound-guided treatment of cronic pain done to two patients with pudendal neuralgia that were refractory to the conservative treatment. MATERIALS AND METHODS: As the diagnostic block done with 0,5-1 ml with 2 percent of lidocaine gave a positive outcome, we perform a pulsed radiofrecuency by an ultrasound-guide to two patients (36 year old female and a 54 year old male) with pudendal neuralgia diagnosted according to Nantes criteria and a tracing of 1 week and 1 month of the procedure was performed observing the pain evolution through visual analogue scale, quality of life according to the as reported in consultation and evolution in the intake and dose of medications. RESULTS: The reduction of pain was significant in both cases, in patient 1 (female) the VAS went from 10/10 (preoperative) to 1/10 to a week of the procedure and disappeared completely to 1 month, with the medicines completely withdrawn indicated for pudendal neuralgia. The female patient (1) showed improvement in the quality of life by not having pain during intercourse. On the other hand, in patient 2 (male), the pain was reduced by 50 percent, registering an EVA that went from 8/10 (preoperative) to 4/10 to 1 week and 1 month after the procedure was performed. In his case, since the pain had not completely disappeared, he continued to take the indicated medication (duloxetine 30 mg) and referred to be able to sit comfortably, without the intense pain that afflicted him in this position, even being able to travel long distances. DISCUSSION: Pulsed radiofrequency is an effective procedure in those patients correctly diagnosed with pudendal neuralgia according to the Nantes criterion, refractory to pharmacological and / or physiotherapeutic treatment, practiced by professionals with training and / or experience in the pulsed radiofrequency technique as well as in the management of ultrasound to locate the pudendal nerve sonoanatomically, in a safe environment for carrying out the procedure.

Treatment of Lung Cancer-Related Intractable Hiccups Using Pulsed Radiofrequency: Clinical Experience / 한국호스피스완화의료학회지

While most benign hiccups can be controlled with empirical therapy, intractable hiccups lasting longer than one month tend to have significant adverse effects with obscure etiology. Treatment strategies for intractable hiccups have not been established. Only a few sporadic cases of bilateral phrenic nerve blockage have been reported. Here, we report a case of intractable hiccups that lasted five weeks in a 56-year-old male patient with a lung cancer above the right diaphragm. We hypothesized that his intractable hiccups were caused by irritation and mass effect caused by the lung cancer. We performed an ultrasound-guided right unilateral phrenic nerve pulsed radiofrequency treatment, and the patient's intractable hiccups were successfully managed without complication.

Radiating Pain and Postural Balance with Pulsed Radiofrequency Treatment in Patients with Lumbosacral Radiculopathy

OBJECTIVE: To investigate the effect of pulsed radiofrequency (PRF) treatment on pain and balance in patients with lumbosacral radiculopathy.METHOD: This study included twenty-five patients who were diagnosed with chronic lumbosacral radiculopathy. They underwent PRF treatment in prone position under the fluoroscopic guidance. The effect of PRF was measured by the visual analog score (VAS). Patient ability to balance was evaluated by using the Tetra-ataxiometric posturography (Tetrax).RESULTS: After PRF all patients showed improvement in pain as measured by VAS (p < 0.001) and none of the patients reported any side effects. The posturographic balance, which was evaluated by Tetrax showed no significant decline after PRF treatment. The weight distribution index (WDI) with eyes open before treatment was 5.43 ± 2.88 and after treatment was 5.37 ± 2.65 (p=0.917). The mean stability index (SI) with eyes open before treatment was 16.52 ± 6.05 and after treatment was 16.61 ± 4.85 (p=0.906). The mean WDI with eyes closed before treatment was 5.66 ± 2.81 and after treatment was 5.16 ± 2.70 (p=0.470). Finally, the mean SI with eyes closed before was 25.88 ± 9.88 and after treatment was 25.99 ± 12.30 (p=0.962).CONCLUSION: The results suggest that PRF has an effect on pain in patients with chronic lumbosacral radiculopathy. The patients did not experience adverse effects, such as hypoesthesia, dysesthesia and decreased proprioception after PRF, and there were no significant declines in balance.

Extended duration pulsed radiofrequency for the management of refractory meralgia paresthetica: a series of five cases

Meralgia paresthetica (MP) is a sensory mononeuropathy, caused by compression of the lateral femoral cutaneous nerve (LFCN) of thigh. Patients refractory to conservative management are treated with various interventional procedures. We report the first use of extended duration (8 minutes) pulsed radiofrequency of the LFCN in a case series of five patients with refractory MP. Four patients had follow up for 1–2 years, and one had 6 months follow up. All patients reported remarkable and long lasting symptom relief and an increase in daily life activities. Three patients came off medications and two patients required minimal doses of neuropathic medications. No complications were observed.

Efficacy of Treatment with Coblation Turbinate Reduction in Patients with Allergic Rhinitis Responding to Medication / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effectiveness of turbinate surgery has been well demonstrated in allergic rhinitis refractory to medication. On the contrary, the efficacy of surgery in allergic rhinitis that responds to medication has not been assessed. The aim of this study was to determine the surgical outcomes in patients with allergic rhinitis responsive to medication. SUBJECTS AND METHOD: Patients with allergic rhinitis responsive to medication and those who had undergone coblation turbinate reduction were enrolled in this study. The visual analog scale was used to assess the allergic symptoms before treatment, during medication treatment as well as postoperatively at 6 and 12 months. In addition, the degree of patient satisfaction regarding the surgery was investigated postoperatively at 12 months. RESULTS: Twenty-four patients (mean age=33.6±14.9 years; men-to-women ratio=1:1) were included in this study. During the pretreatment period, all allergic symptoms significantly improved after treatment with both medication and surgery. At 6 months postoperatively, the degree of patients' allergic symptoms was lower than in those treated with medication. However, when compared at 12 months postoperatively, all the symptoms, excluding nasal obstruction, were not significantly different from those who received medication. Surveyed postoperatively at 12 months 54.2% of patients advocated for surgical treatment. CONCLUSION: Although surgery yielded better outcome than did medication during the early postoperative period, there was little difference in the outcome at 12 months postoperatively. Therefore, we need to be careful when choosing surgical intervention for patients with allergic rhinitis responsive to medication.

Multimodal therapeutic approach of vaginismus: an innovative approach through trigger point infiltration and pulsed radiofrequency of the pudendal nerve / Terapêutica multimodal do vaginismo: abordagem inovadora por meio de infiltração de pontos gatilho e radiofrequência pulsada do nervo pudendo

Abstract Vaginismus is a poorly understood disorder, characterized by an involuntary muscular spasm of the pelvic floor muscles and outer third of the vagina during intercourse attempt, which results in aversion to penetration. It is reported to affect 1-7% of women worldwide. With this report the authors aim to describe the case of a young patient with vaginismus in whom techniques usually from the chronic pain domain were used as part of her multimodal therapeutic regimen.

Resumo O vaginismo é uma doença pouco compreendida que se caracteriza por uma contração muscular involuntária dos músculos do pavimento pélvico e do terço externo da vagina durante as tentativas de intercurso sexual, o que resulta em aversão à penetração. Estima-se que possa afetar entre 1%-7% da população feminina mundial. Com este relato os autores pretendem apresentar o caso de uma paciente jovem com vaginismo na qual foram usadas técnicas habitualmente do domínio da medicina da dor crônica como parte do seu esquema terapêutico multimodal.

Congenital saccular cyst of the larynx. case report and literature review

ABSTRACT Introduction: Congenital saccular cyst is a rare but benign lesion, caused by a dilated laryngeal sac full of mucus that does not communicate with the laryngeal lumen. Its definitive treatment is surgical according to the literature. Objective: To review the literature and report a case of congenital laryngeal saccular cyst, as well as its treatment by endoscopic approach and radiofrequency, which is most easily found in our country. Materials and methods: Presentation of a case report and literature review in PubMed and Tripdatabase using the described keywords. Results: This is a rare condition with an incidence of 1.82 cases per 100 000 live births. Diagnosis is achieved by laryngeal endoscopy, images or clinical review. The case reported here corresponds to a newborn patient with respiratory distress and stridor, who was diagnosed with laryngeal saccular cyst that was resected surgically by means of endoscopy and radiofrequency, with no subsequent recurrence. Discussion: Understanding this disease is highly important to achieve proper diagnosis and provide treatment using the resources available in our country, such as radiofrequency. Conclusions: Despite the lack of case reports, knowing the characteristics of congenital saccular cyst is necessary to indicate proper treatment based on the available resources. It is possible to perform endoscopic resection of this lesion if it is <3cm by means of radiofrequency, which is a safe and effective method.

RESUMEN Introducción. El quiste sacular congénito es una lesión rara, pero benigna, dada por la dilatación del sáculo laríngeo que se llena de moco y que no se comunica con el lumen laríngeo. Según la literatura, su tratamiento definitivo es quirúrgico. Objetivo. Realizar una revisión de la literatura y el reporte de un caso de quiste sacular laríngeo congénito y su tratamiento mediante abordaje endoscópico y uso de radiofrecuencia. Materiales y métodos. Se realizó la presentación del caso clínico y se llevó a cabo una revisión de la literatura en las bases de datos de Pubmed y Tripdatabase usando palabras claves descritas. Resultados. Esta patología es escasa, con una incidencia de 1.82 casos por 100 000 nacidos vivos. El diagnostico se realiza por medio de endoscopia laríngea, imágenes o revisión de la clínica. El caso expuesto es de una paciente recién nacida que presenta estridor y dificultad respiratoria y es diagnosticada con quiste sacular laríngeo, el cual es resecado de forma quirúrgica por medio de endoscopia con uso de radiofrecuencia. El procedimiento da como resultado la no reaparición del quiste. Conclusiones. Pese a no existir muchos reportes de caso, hay que conocer las características del quiste sacular congénito para poder realizar el tratamiento adecuado con los recursos disponibles. Es posible realizar resección endoscópica de esta lesión si es <3cm por medio de radiofrecuencia, un método seguro y eficaz.

Osteoid osteoma - radiofrequency ablation treatment guided by computed tomography: a case series / Osteoma osteoide - Tratamento com radioablação guiada por tomografia computadorizada: uma série de casos

ABSTRACT The osteoid osteoma is a benign primary bone tumor that affects mainly males in the second and third decades of life. Radiographic findings show a radiolucent nidus surrounded by reactive sclerotic bone, particularly in the long bones of the lower extremity. Clinically, it presents persistent pain, which is worse at night and improves with salicylates. It can be a self-limiting injury, with an average duration of three years, but because of pain intensity and intolerance to prolonged use of nonsteroidal anti-inflammatories, surgical treatment is an option. The diagnosis is suspected according to the history and radiographic findings, and the confirmation is made by histological analysis. The traditional surgical treatment is the complete excision of the nidus, but some disadvantages have been described, such as difficulties in localizing the lesion and risk of fracture during the procedure, hospital stay for pain control, and unfavorable esthetic outcome. The authors report a series of cases treated with thermal radiofrequency ablation guided by computed tomography in this service. It is a safe and an effective percutaneous method that aims to cure, minimizing the trauma and morbidity when compared with the conventional block-resection method.

RESUMO O osteoma osteoide é um tumor ósseo primário benigno que acomete mais o sexo masculino na segunda e terceira décadas da vida. Radiograficamente, caracteriza-se por um nicho radiolucente cercado por osso esclerótico reativo, principalmente em ossos longos da extremidade inferior. Clinicamente, apresenta uma dor persistente de longa duração, com pioria noturna e melhoria com salicilatos. Embora possa ser uma lesão autolimitada, com duração média de três anos, a ressecção da lesão é uma opção de tratamento devido à intensidade da dor e intolerância ao uso prolongado de anti-inflamatórios não hormonais. Sua suspeita diagnóstica baseia-se principalmente na história clínica e nos achados radiográficos, a confirmação é feita pelo estudo anatomopatológico. O tratamento cirúrgico clássico é a excisão cirúrgica completa do nicho, porém são descritas desvantagens como a dificuldade para a localização intraoperatória da lesão, risco de fratura durante o procedimento, tempo de internação hospitalar para controle álgico e resultado estético desfavorável. Relatamos uma série de casos tratados com termoablação por radiofrequência guiada por tomografia computadorizada em nosso serviço. Trata-se de um método percutâneo seguro e eficaz que tem como objetivo a cura, minimiza o trauma e a morbidade do procedimento, quando comparado com o método convencional de ressecção em bloco.

New Radiofrequency Device to Reduce Bleeding after Core Needle Biopsy: Experimental Study in a Porcine Liver Model

OBJECTIVE: To evaluate the in vivo efficiency of the biopsy tract radiofrequency ablation for hemostasis after core biopsy of the liver in a porcine liver model, including situations with bleeding tendency and a larger (16-gauge) core needle. MATERIALS AND METHODS: A preliminary study was performed using one pig to determine optimal ablation parameters. For the main experiment, four pigs were assigned to different groups according to heparinization use and biopsy needle caliber. In each pig, 14 control (without tract ablation) and 14 experimental (tract ablation) ultrasound-guided core biopsies were performed using either an 18- or 16-gauge needle. Post-biopsy bleeding amounts were measured by soaking up the blood for five minutes. The results were compared using the Mann-Whitney U test. RESULTS: The optimal parameters for biopsy tract ablation were determined as a 2-cm active tip electrode set at 40-watt with a tip temperature of 70–80℃. The bleeding amounts in all experimental groups were smaller than those in the controls; however they were significant in the non-heparinized pig biopsied with an 18-gauge needle and in two heparinized pigs (p < 0.001). In the heparinized pigs, the mean blood loss in the experimental group was 3.5% and 13.5% of the controls biopsied with an 18- and 16-gauge needle, respectively. CONCLUSION: Radiofrequency ablation of hepatic core biopsy tract ablation may reduce post-biopsy bleeding even under bleeding tendency and using a larger core needle, according to the result from in vivo porcine model experiments.

Rhonchopathie chronique : quelle chirurgie pour quels patients ?

Faisant partie de l'arsenal thérapeutique du ronflement, la chirurgie garde encore à ce jour un intérêt majeur. L'efficacité des traitements chirurgicaux est très difficile à évaluer, en raison principalement de l'hétérogénéité des critères d'évaluation rapportés dans la littérature, d'un recul très variable selon les séries, et surtout de la méthodologie des études.Nous avons mené une étude sur 105 patients qui ont été opérés pour le ronflement. Nos résultats ont été rapportés selon différents groupes plus homogènes permettent une comparaison plus fine des résultats. L'analyse univariée a montré un meilleur résultat de la chirurgie chez les ronfleurs simples par rapport aux apnéiques (p=0.03), l'efficacité de la chirurgie en cas d'apnées du sommeil se voyait surtout sur le volume sonore et non sur l'index d'apnées hypopnées. En analyse multivariée, nous avons dégagé le profildes malades chez qui le traitement chirurgical aurait de meilleurs résultats : jeune âge, non obèse, sans rétrognatisme avec un voile long et/ou flasque et avec un index apnées hypopnées< 30

Abordaje intervencionista del síndrome facetario lumbar: denervación con radiofrecuencia / Interventional approach for lumbar facet syndrome: radio frequency denervation

Lumbar pain is a common and frequent chronic condition. It is estimated that facet joint pain represents 15-31% of all consultations for low back pain. In suspected facet joint pain, it is recommended to perform nerve blocks to establish the diagnosis. Percutaneous continuous radiofrequency is the most effective treatment to date. We describe the current evidence on the minimally invasive treatment of lumbar facet syndrome and our experience with image guidance with CT and fluoroscopy by means of rhizolysis of the medial branch of the dorsal primary ramus of the spinal nerve.

El dolor lumbar es una entidad común y frecuente crónica. Se estima que el dolor de causa articular facetaria representa el 15-31% de todas las consultas por dolor lumbar. En sospecha de dolor articular facetario se recomienda realización de bloqueos nerviosos para establecer el diagnóstico. La radiofrecuencia continua percutánea es el tratamiento más efectivo hasta la fecha. Se describe la evidencia actual en el tratamiento mínimamente invasivo del síndrome facetario lumbar y nuestra experiencia con las guías de imagen con TC y fluoroscopía mediante rizolisis de la rama medial del ramo primario dorsal del nervio espinal.

Radiofrecuencia pulsada del ganglio de la raíz dorsal en un caso de sindrome radicular lumbosacro crónico refractario a los esteroides epidurales / Pulsed radiofrequency of dorsal root glanglion a clinical case of chronic lumbosacro syndrome refractory to epidural steroids

Las inyecciones epidurales de esteroides son frecuentemente indicadas en el sindrome radicular lumbosacro, producido por hernias de disco, protrusiones discales o estenosis del canal, cuando éste no responde al tratamiento no intervencionista. Sin embargo, por distintas causas, aproximadamente 20% de los pacientes no responden a estas inyecciones, quedando pocas opciones terapéuticas disponibles. La radiofrecuencia pulsada del Ganglio de la Raíz Dorsal de las raíces afectadas es una alternativa válida para tratar el sindrome cuando es refractario al tratamiento con inyecciones epidurales de esteroides, en caso de que la cirugía de columna no está indicada o se prefiera evitar. Se presenta un caso clínico de un sindrome radicular lumbosacro refractario, causado por protrusiones discales lumbares, donde se utilizó la radiofrecuencia pulsada del ganglio de la raíz dorsal con buenos resultados, evaluados mediante el Inventario Abreviado del Dolor (Brief Pain Inventory).

Lumbosacral radicular syndrome, produced by discs herniations, discs protrusions or spinal stenosis is frequently treated by injecting steroids in the epidural space. However, 20% of the patients are resistant to this treatment, so few therapeutics options for them are left. Pulsed radiofrequency of the Dorsal Root Ganglion is a validated therapeutic option, when the syndrome is refractory to epidural steroid injections and spinal surgery is not indicated or elected. We report a clinical case of a lumbosacral radicular syndrome, refractory to epidural steroid injections, successfully treated with pulsed radiofrequency of lumbar Dorsal Root Ganglion, utilizing the Spanish version of the Brief Pain Inventory, as an outcome evaluation tool.

Complications of non-endoscopic discectomy: a retrospective study of twenty-one years / Complicações da discotomia não endoscópica: estudo retrospectivo de vinte e um anos / Complicaciones de la discectomía no endoscópica: estudio retrospectivo de veintiún años

ABSTRACT Objective: To report and compare the number and grade of major complications presented with non-endoscopic thermal discectomy and nucleoplasty for the treatment of discogenic axial lumbar pain using laser and radiofrequency. Methods: A 21 years retrospective study was conducted of the clinical charts of patients whose reason for consultation was axial lumbar pain from degenerative disc disease, and who underwent surgery using non-endoscopic discectomy and nucleoplasty (NEDN). Two groups were established; the first, NEDN with laser, and second, NEDN with radiofrequency. The number and types of complications reported in the case-series were counted, and their statistical differences determined. Results: The inclusion criteria were fulfilled by 643 of the medical charts. 26 complications were reported, the most common being radiculitis (n=12). Statistically significant differences were found between the complications occurring in the two groups (p=0.01). Conclusion: The number of complications showed statistically significant difference. The severity of the complications and adverse outcomes provide an argument for choosing one technology over the other. Training and the learning curve stage are important factors to be taken into account, to avoid complications.

RESUMO Objetivo: Relatar e comparar o número e grau das complicações importantes apresentadas com discotomia e nucleoplastia térmica não endoscópica no tratamento da dor lombar axial discogênica usando laser e radiofrequência. Métodos: Estudo retrospectivo de 21 anos, realizado com os prontuários clínicos de pacientes cujo motivo da consulta foi dor lombar axial por doença degenerativa do disco, que foram submetidos a cirurgia empregando discotomia e nucleoplastia não endoscópica (NEDN). Dois grupos foram estabelecidos, o primeiro, NEDN com laser e o segundo, NEDN com radiofrequência. O número e os tipos de complicações relatadas na série de casos foram contabilizados, e suas diferenças estatísticas foram determinadas. Resultados: Os critérios de inclusão foram satisfeitos por 643 prontuários clínicos. Foram relatadas 26 complicações, sendo a mais comum a radiculite (n = 12). Foram encontradas diferenças estatisticamente significativas (p = 0,01) entre as complicações que ocorreram nos dois grupos. Conclusão: O número de complicações mostrou diferença estatisticamente significativa. A gravidade das complicações e os resultados adversos fornecem um argumento para a escolha de uma tecnologia sobre a outra. O treinamento e a curva de aprendizagem são fatores importantes a considerar para evitar complicações.

RESUMEN Objetivo: Relatar y comparar el número y grado de las complicaciones importantes que se presentaron con la discectomía y nucleoplastia térmica no endoscópica para el tratamiento del dolor lumbar axial discogénico utilizando láser y radiofrecuencia. Métodos: Estudio retrospectivo de 21 años de las historias clínicas de pacientes cuyo motivo de consulta fue el dolor lumbar axial debido a enfermedad degenerativa del disco, que fueron sometidos a cirugía mediante discectomía y nucleoplastia no endoscópica (NEDN). Se establecieron dos grupos, el primero, NEDN con láser y el segundo, NEDN con radiofrecuencia. Se contaron el número y los tipos de complicaciones relatadas en la serie de casos, y se determinaron sus diferencias estadísticas. Resultados: Los criterios de inclusión fueron satisfechos por 643 historias clínicas. Se encontraron 26 complicaciones, siendo la más común la radiculitis (n = 12). Se encontraron diferencias estadísticamente significativas entre las complicaciones ocurridas (p = 0,01). Conclusión: El número de complicaciones mostró una diferencia estadísticamente significativa. La gravedad de las complicaciones y los resultados adversos proporcionan un argumento para elegir una tecnología sobre la otra. La capacitación y la curva de aprendizaje son factores importantes a tener en cuenta para evitar complicaciones.

Comparison of nerve combing and percutaneous radiofrequency thermocoagulation in the treatment for idiopathic trigeminal neuralgia / Comparação entre neurólise interna e termocoagulação percutânea por radiofrequência no tratamento da neuralgia idiopática do trigêmeo

ABSTRACT INTRODUCTION: Idiopathic trigeminal neuralgia (ITN) is a common pain disease in elderly people. Many methods have been used to alleviate the pain of patients, but few studies in the literature have compared the effect of nerve combing and percutaneous radiofrequency thermocoagulation. OBJECTIVE: The purpose of this study was to describe and evaluate the clinical outcome of idiopathic trigeminal neuralgia after nerve combing (NC) and compare them with those obtained using percutaneous radiofrequency thermocoagulation (RF). METHODS: The study included 105 idiopathic trigeminal neuralgia patients with similar symptom, age and underlying disease, which were divided into two groups. One group was treated by nerve combing (50 patients), the other by RF (55 cases). All patients were considered medical failures prior to the surgeries. A questionnaire was used to assess the long-term outcomes: pain relief, recurrence, complication and need for additional treatment. RESULTS: The median duration of follow-up in both groups was 90 months. Satisfactory relief was noted in 41 patients (82%), 5 patients (10%) initially experienced pain relief, then recurred, and four patients (8%) were designated poor among the group NC. In the group RF, satisfactory relief was noted in 42 patients (76.4%). There were eight "pain free with recurrence patients (14.5%) and 5 poor cases (9.1%). No statistically significant differences existed in the outcomes between both groups (p > 0.05). Postoperative morbidity included dysesthesia, diplopia, partial facial nerve palsy, hearing loss, tinnitus, cerebrospinal fluid leak, meningitis and mortality. CONCLUSION: Nerve combing and RF are both satisfactory treatment strategies for patients with ITN. Because of the higher risk of sensory morbidity and surgical risk as open surgery, RF is preferred as the recommended procedure for patients with ITN.

Resumo Introdução: A neuralgia idiopática do trigêmeo (NIT) é uma condição dolorosa comum em idosos. Muitos métodos têm sido usados para aliviar a dor dos pacientes, mas poucos estudos na literatura compararam o efeito de neurólise interna e termocoagulação percutânea por radiofrequência. Objetivo: O objetivo desse estudo foi descrever e avaliar o desfecho clínico de pacientes com neuralgia idiopática do trigêmeo após neurólise interna (NI) e compará-los com os obtidos usando termocoagulação percutânea por radiofrequência (RF). Método: O estudo incluiu 105 pacientes com NIT com sintomas, idade e doenças de base semelhantes, que foram divididos em dois grupos. Um grupo foi tratado por neurólise interna (50 pacientes) e o outro por RF (55 casos). Todos os pacientes haviam sido considerados fracassos terapêuticos antes das cirurgias. Um questionário foi utilizado para avaliar os resultados a longo prazo: alívio da dor, recorrência, complicações e necessidade de tratamento adicional. Resultados: A duração média do acompanhamento foi de 90 meses em ambos os grupos. Alívio satisfatório foi observado em 41 pacientes (82%); cinco pacientes (10%) experimentaram alívio inicial da dor, porém seguido de recrudescimento, e quatro pacientes (8%) apresentaram desfecho desfavorável no grupo NI. No grupo de RF, alívio satisfatório foi observado em 42 pacientes (76,4%). Houve oito pacientes livres de dor, com recorrência ''LDR'' (14,5%) e cinco casos com desfecho desfavorável (9,1%). Não houve diferenças significantes nos resultados entre os dois grupos (p > 0,05). Morbidade pós-operatória incluiu disestesia, diplopia, paralisia parcial do nervo facial, perda auditiva, tinnitus, fístula liquórica, meningite e óbito. Conclusão: Neurólise interna e RF são estratégias satisfatórias de tratamento para os pacientes com NIT. Em decorrência da maior morbidade sensorial e maior risco cirúrgico em uma cirurgia aberta, a RF é o procedimento mais indicado para pacientes com NIT.

Guía práctica para el tratamiento intervencionista del síndrome radicular lumbosacro (SRL) / Practical guide for interventional treatment of lumbosacral radicular syndrome (LRS)

Introducción: El Síndrome Radicular Lumbosacro (SRL) es una consulta frecuente de dolor neuropático causado por hernias y protrusiones discales o fenómenos degenerativos de la columna lumbosacra. Las técnicas intervencionistas de tratamiento se indican cuando otras terapéuticas no invasivas no alcanzan alivio satisfactorio. Dentro de ellas, las Inyecciones Epidurales de Corticoides (IEC) y la Radiofrecuencia Pulsada del Ganglio de la Raíz Dorsal (RPGRD) son las más indicadas en nuestro Servicio. No disponemos de guías nacionales para su utilización, basándonos habitualmente en las recomendaciones internacionales. Objetivo: Realizar una revisión bibliográfica que apoye la confección de una guía para la toma de decisiones, en cuanto a los aspectos prácticos de las técnicas disponibles, de manera de aplicarlas obteniendo el máximo beneficio posible, reduciendo al mínimo sus riesgos. Discusión: Se discuten las ventajas y desventajas de los abordajes más utilizados para la aplicación de las IEC, así como los agentes farmacológicos disponibles para este fin. Finalmente, se realiza también una puesta al día de los aspectos técnicos de la RPGRD para el tratamiento del SRL refractario al tratamiento con corticoides epidurales.

Introduction: Lumbosacral Radicular Syndrome (LRS) is a frequent neuropathic pain due to disc herniation, disc protrusions or degenerative changes of the lumbosacral spine. Interventional Pain Management techniques for its treatment are indicated when conservative management fails in provide satisfactory pain relief. Epidural Steroid Injections (ESI) and Pulsed Radiofrequency of the Dorsal Root Ganglion (PRDRG) are the procedures most frequently performed in our Service, for LRS treatment. Since guidelines for its use are lacked in our Country, international recommendations are usually followed. Objectives: The aim of this article is to perform a literature search to give evidence support to National guidelines related to available Interventional Pain Management techniques for LRS treatment, in order to balance risks and benefits of each technique in the decision making process. Discussion: Advantages and disadvantages of the different approaches for ESI are discussed and the pharmacologic aspects of the available agents for its use are summarized. Finally, an update of technical aspects of PRGDR for ESI refractory LRS is performed.

Treatment of lumbar hernias by endoscopic nucleoplasty with radiofrequency / Tratamento de hérnias de disco lombar por nucleoplastia endoscópica com radiofrequência / Manejo de hernias de disco lumbar mediante nucleoplastía endoscópica con radiofrecuencia

ABSTRACT Objective: To evaluate the postoperative outcomes of minimally invasive technique for treating lumbar disc herniation in patients undergoing percutaneous endoscopic nucleoplasty with radiofrequency in the center of minimally invasive procedures Veracruz (CEMIVER) of the HRAEV.. Methods: A descriptive, comparative, ambispective and longitudinal study. The clinical records of patients who underwent herniated disc surgery were reviewed from March 2010 to March 2015. Inclusion criteria were individuals of both sexes, aged 18-65 years, with disc herniation diagnosis by MRI, evocative discography (pain) and clinical evaluation. The variables were analyzed by VAS, Oswestry disability index for functional assessment and Macnab criteria for modified retrospective cross clinical classification. Results: 161 patients were included, 81 female and 80 male, aged between 18 and 65 years with severe (83.8%) and moderate (16.2%) disability according to the Oswestry disability index; the total of excellent results was 83.8%, 9.5% were good, 4.8% were median and 1.9% were poor results, according to the Macnab criteria; the average time of surgery was 84 minutes per procedure, and the postoperative average bleeding was 65 ml. Of the total, 87.4% of the patients were on an outpatient basis and 7.6% had a short hospital stay.. Conclusion: It was found that percutaneous endoscopic nucleoplasty with radiofrequency technique is a procedure that offers great benefits for patients with lumbar disc herniation, including performing it under local anesthesia, with clear visualization of the surgical field, minimal pain, little bleeding, shorter operative time, does not cause instability of anatomical structures and has minimal rate of complications.

RESUMEN Objetivo: Evaluar resultados postquirúrgicos de técnica mínimamente invasiva para el tratamiento de hernias discales lumbares en pacientes sometidos a nucleoplastía endoscópica percutánea con radiofrecuencia en el centro de mínima invasión de Veracruz (CEMIVER) del HRAEV. Métodos: Estudio descriptivo, comparativo, ambispectivo y longitudinal. Se revisarán expedientes clínicos de pacientes después de cirugía de hernia discal en el periodo de marzo de 2010 a marzo de 2015. Los criterios de inclusión fueron sujetos de ambos sexos, con edades entre 18 y 65 años con diagnóstico de hernia de disco mediante resonancia magnética nuclear, discografía evocativa de dolor y evaluación clínica. Se dimensionaron las variables mediante escala EVA, Índice de discapacidad de Oswestry para valoración funcional y criterios de Macnab modificados para graduación clínica transversal retrospectiva. Resultados: Se incluyeron 161 pacientes, 81 mujeres y 80 hombres, con edades comprendidas entre 18 y 65 años, con discapacidad grave (83,8%) y moderada (16,2%) de acuerdo con el índice de discapacidad de Oswestry; se obtuvo un total de 83,8% resultados excelentes, 9,5% buenos, 4,8% medianos y 1,9% resultados pobres según los criterios de Macnab; el tiempo quirúrgico medio fue de 84 minutos por procedimiento, el sangrado postquirúrgico medio fue 65 ml, un total de 87,4% de los pacientes operados tuvieron estancia ambulatoria, 7,6% tuvieron estancia hospitalaria corta. Conclusión: Se comprueba que la técnica de nucleoplastía endoscópica percutánea con radiofrecuencia es un procedimiento que brinda grandes beneficios al paciente con hernias discales lumbares, incluyendo, realización bajo anestesia local, con clara visualización del campo quirúrgico, mínimo dolor, escaso sangrado, menor tiempo quirúrgico, no causa inestabilidad de estructuras anatómicas y tiene tasa mínima de complicaciones.

RESUMO Objetivo: Avaliar os resultados pós-operatórios de técnica minimamente invasiva no tratamento de hérnia de disco lombar em pacientes submetidos à nucleoplastia endoscópica percutânea com radiofrequência no centro de procedimentos minimamente invasivos Veracruz (CEMIVER) do HRAEV. Métodos: Estudo descritivo, comparativo, ambispectivo e longitudinal. Foram revisados os prontuários clínicos de pacientes submetidos à cirurgia de hérnia de disco no período de março de 2010 a março de 2015. Os critérios de inclusão foram indivíduos de ambos os sexos, na faixa etária de 18 a 65 anos com diagnóstico de hérnia de disco por ressonância magnética nuclear, discografia evocativa da dor e avaliação clínica. As variáveis foram analisadas por EVA, Índice de incapacidade de Oswestry para avaliação funcional e critérios de Macnab modificados para classificação clínica transversal retrospectiva. Resultados: Foram incluídos 161 pacientes, sendo 81 do sexo feminino e 80 do sexo masculino, com faixa etária entre 18 e 65 anos, com incapacidade grave (83,8%) e moderada (16,2%) de acordo com o Índice de incapacidade de Oswestry; o total de resultados excelentes foi 83,8%, 9,5% foram bons, 4,8% foram medianos e 1,9% foram resultados ruins, segundo os critérios de Macnab; o tempo médio de cirurgia foi 84 minutos por procedimento, a hemorragia pós-cirúrgica média foi 65 ml. Do total, 87,4% dos pacientes operados ficaram em ambulatório e 7,6% tiveram internação hospitalar curta. Conclusão: Constatou-se que a técnica de nucleoplastia endoscópica percutânea com radiofrequência é um procedimento que oferece grandes benefícios para os pacientes com hérnia de disco lombar, entre os quais, realização sob anestesia local, com clara visualização do campo cirúrgico, dor mínima, pouco sangramento, menor tempo cirúrgico, não causa instabilidade de estruturas anatômicas e tem taxa mínima de complicações.

Sphenopalatine ganglion pulsed radiofrequency treatment in patients suffering from chronic face and head pain / Tratamento com radiofrequência pulsada para gânglio esfenopalatino em pacientes com dor crônica de face e cabeça

PURPOSE: There are various facial pain syndromes including trigeminal neuralgia, trigeminal neuropathic pain and atypical facial pain syndromes. Effectiveness of the pulsed radiofrequency in managing various pain syndromes has been clearly demonstrated. There are a limited number of studies on the pulsed radiofrequency treatment for sphenopalatine ganglion in patients suffering from face and head pain. The purpose of this study is to evaluate the satisfaction of pulsed radiofrequency treatment at our patients retrospectively. METHODS: Infrazygomatic approach was used for the pulsed radiofrequency of the sphenopalatine ganglion under fluoroscopic guidance. After the tip of the needle reached the target point, 0.25-0.5 ms pulse width was applied for sensory stimulation at frequencies from 50 Hz to 1 V. Paraesthesias were exposed at the roof of the nose at 0.5-0.7 V. To rule out trigeminal contact that led to rhythmic mandibular contraction, motor stimulation at a frequency of 2 Hz was applied. Then, four cycles of pulsed radiofrequency lesioning were performed for 120 s at a temperature of 42 °C. RESULTS: Pain relief could not be achieved in 23% of the patients (unacceptable), whereas pain was completely relieved in 35% of the patients (excellent) and mild to moderate pain relief could be achieved in 42% of the patients (good) through sphenopalatine ganglion-pulsed radiofrequency treatment. CONCLUSION: Pulsed radiofrequency of the sphenopalatine ganglion is effective in treating the patients suffering from intractable chronic facial and head pain as shown by our findings. There is a need for prospective, randomized, controlled trials in order to confirm the efficacy and safety of this new treatment modality in chronic head and face pain.

OBJETIVO: Existem várias síndromes de dor facial, incluindo neuralgia trigeminal, dor neuropática trigeminal e síndromes atípicas de dor facial. A eficácia da radiofrequência pulsada (RFP) para o manejo de várias síndromes de dor foi claramente demonstrada. Há um número limitado de estudos sobre o tratamento com RFP para gânglio esfenopalatino (GEP) em pacientes que sofrem de dor facial e de cabeça. O objetivo deste estudo foi avaliar a satisfação do tratamento com PRF em nossos pacientes, retrospectivamente. MÉTODOS: A abordagem infrazigomática foi usada para a RFP do GEP sob orientação fluoroscópica. Depois de a ponta da agulha atingir o ponto alvo, pulsos de 0,25 a 0,5 ms foram aplicados para a estimulação sensorial em frequências de 50 Hz a 1 V. Parestesias foram expostas no teto do nariz em 0,5 a 0,7 V. Para excluir o contato trigeminal que levou à contração mandibular rítmica, a estimulação motora foi aplicada na frequência de 2 Hz. Em seguida, quatro ciclos de RFP foram feitos durante 120 segundos a uma temperatura de 42 °C. RESULTADOS: O alívio da dor não foi obtido em 23% dos pacientes (inaceitável); enquanto a dor foi totalmente aliviada em 35% dos pacientes (excelente) e o alívio de leve a moderado da dor foi obtido em 42% dos pacientes (bom), com o tratamento RFP-GEP. CONCLUSÃO: RFP para GEP é eficaz no tratamento de pacientes que sofrem de dor crônica intratável, facial e de cabeça, como mostrado por nossas descobertas. Estudos prospectivos, randômicos e controlados são necessários para confirmar a eficácia e segurança dessa nova modalidade de tratamento para dor crônica facial e de cabeça.

Radiofrequency ablation combined with transarterial chemoembolization for liver metastases from gastrointestinal cancers / 华中科技大学学报（医学）（英德文版）

Transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) has been reported to be effective for local control of different-sized hepatocellular carcinomas. However, it is unclear if these benefits could also be applicable to different-sized liver metastases from gastrointestinal cancers. The aim of this study was to evaluate the outcomes of TACE combined with RFA for liver metastases from gastrointestinal cancers. In this study, we retrospectively analyzed clinical data of 19 consecutive patients who had a total of 26 liver metastatic lesions from gastrointestinal cancers and underwent RFA followed by first-time TACE treatment. The tumor recurrence, overall survival rate and procedure-related complications were evaluated. Moreover, patients' demographics and tumor characteristics were analyzed to determine their impact on the outcomes. The technical success of TACE plus RFA was achieved with 2 major procedure-related complications found. The mean follow-up was 21.3 months. The total 1-, 2-, and 3-year survival rate was 89.4%, 52.6%, and 35.1%, respectively. It was found that the tumor size and the ratio of enhancement area were significant factors that influenced the overall survival. In conclusion, patients with gastrointestinal cancer-derived liver metastatic lesions of smaller size and larger enhancement area are considered appropriate candidates for TACE plus RFA.