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AMU Medical College: Successful trial of radiofrequency lesioning of facet joints

AligarhJune 12:The doctors at Pain Clinic OPD of the Department of
Anaesthesiology, J. N. Medical College Hospital carried out the
successful trial of radiofrequency lesioning of facet joints for
patients suffering from back pain. This trial was made by the
radiofrequency machine brought by Mr. Naveen from the Advanced
Neurostimulation System (ANS), New Delhi. The radiofrequency system is
the most advanced system for the management of different painful
conditions. This is a totally non pharmacological system where the
patient is managed with minimum or no drugs. This technique proved to
be the most reliable and safe technique for patients suffering from
low back pain. Since thepatient require minimum amount of medication
for pain relief after radiofrequency application. Hence this technique
is cost effective for the patients as well.
On this occasion Principal and Chief medical superintendent J. N.
Medical College Hospital, Prof. Ashraf Mallik congratulate the
Chairman, D0epartment of Anaesthesiology Prof. M. M. H. Siddiqi, Prof.
S. Bano, Consultant in Pain Clinic Dr. Hammad Usmani and all faculty
members of the Department for their efforts and expressed his whole
hearted support to procure the machine at the earliest for the benefit
of patients. Chairman, Department of Anaesthesiology Prof. M. M. H.
Siddiqi and Prof. S. Bano showed their keen interest in this technique
and promised all possible help for patients suffering from various
pain problems.
The one day trail was conducted by Dr. Hammad Usmani and his team in
Pain Clinic, J. N. Medical College Hospital on seven patients
suffering from intractable back pain. With the availability of machine
in future, patients suffering from various painful conditions i.e.
cervical pain, back pain, trigeminal neuralgia, neuropathic pain,
complex pain syndromes and cancer pain will be managed with this
technique. The technique will not only make the treatment of pain
problems more effective, it will also prove to be cost effective for
the patients as well as decrease the side effects of excessive use of
analgesic drugs.

From the moderators worldofaligs;An information about the treatment;
Dr raza
Radio Frequency Lesioning – Facet Joints
What is Radio Frequency Lesioning?
This is a procedure that uses a machine (Radio frequency generator) to
generate a current to interrupt nerve conduction on a semi-permanent
basis. The radio frequency current heats the surrounding tissue around
a terminal branch of the nerve and this diminishes transmission of
painful sensations. Radio frequency is a widely used method for
lesioning nervous tissue. With this technique, a high frequency
current is passed down an electrode, through a cannula that is fully
insulated except for its tip. This heats the surrounding tissue from
between 42-80°C and prevents the transmission of pain signals from the
area being treated. This procedure can achieve 60 - 90% pain relief in
many patients for periods of more than a year.
What are Facet Joints?
Facet joints (zygapophyseal joints) are located in the back of the
spine. The facet joints are made up of two facing surfaces from the
vertebra above and below. They stabilise the spine and limit extension
and rotation of the spine. There are two joints one on each side of
the spine at every vertebrae from L5-C1, each of these have two
articulating (moving) surfaces; one surface faces upwards and the
other downwards. The facet joints are surrounded by a capsule of
connective tissue and contain a small amount of fluid, which
lubricates the joints. The surfaces of the facet joints are coated
with cartilage that allows the joints to move smoothly against each
other.
Where and how is the procedure performed?
The procedure will take place in an x-ray theatre, to enable your
doctor to place the radio frequency needles at the appropriate level
for your pain. Nerves cannot be visualised by x-ray; the bones around
the area of the nerves are used as landmarks and can be easily seen
with x-ray.
A nurse or radiographer will take you into the theatre where the
doctor will explain the procedure for you and ask you to sign a
consent form. Please keep your glasses, if needed and bag with you.
When you have signed the consent form the doctor will insert a canula,
probably in your hand, in order to access your vein. This will enable
the nurse to give sedation if required for the procedure.
You will be asked to lie down on the x-ray table, on your front for
lumbar (low back) facet joint denervation or on your back for cervical
(neck) facet joint denervation. A nurse will be with you at all times
and you will be able to talk to her about any aspects of the procedure
as it progresses. You will be offered sedation during the procedure.
The sedation used is a combination of two drugs, which act in
different ways. Fentanyl is used for pain relief and midazolam is a
sedative used to help you relax. The amount of sedation you require
will depend on how well you tolerate the procedure. You will need to
be awake enough to communicate with the doctor and nurses.
How is the procedure performed?
The doctor will place needles in your back or neck under x-ray control
and the radio frequency lesioning will take place at different levels.
Once the needles are in the correct position the tissues surrounding
the needle tip are heated using the Radio Frequency machine, this
usually takes 60 seconds for each level. You need to be awake enough
to report what you are feeling. The procedure takes about half an
hour. During this time the nurse will be monitoring your heart rate,
blood pressure and oxygen saturation. You may require oxygen by a
facemask during the procedure.
What happens after the procedure?
You will be taken back to your recovery area where a nurse will
monitor your progress and you will be able to rest for 30 minutes to
an hour. You will then be offered something to eat or drink prior to
getting up. Most patients are ready to go home an hour after the
procedure is completed. You will not be able to drive yourself due to
the sedation. It is advisable to take things easy on the day of the
procedure. You may find that you experience some muscle soreness for
up to a week after the procedure and it is expected that you will
experience a reduction in your pain after this time. It can take about
3 weeks to experience the maximum pain relief, especially if there is
a muscle pain component to the pain (this may need to be treated, in
addition).
When should I go back to work after the procedure?
You should be able to return to work the next day. If you are
experiencing some pain around the injection sites you may wish to take
a further day or two off work or at least ensure that your workload is
not too heavy.