Radiofrequency lumbar facet denervation: a comparative study of the reproducibility of lesion size after 2 current radiofrequency techniques.
OBJECTIVE
Radiofrequency facet denervation procedures are widely used for the treatment of chronic low-back pain. Currently, both temperature-controlled and voltage-controlled techniques are used. In this combined in vivo and in vitro study, the electrophysiologic consequences and the effects on lesion size of these techniques were determined.


METHODS
Thirty-three patients were randomly assigned to receive a lumbar radiofrequency facet denervation by using either temperature-controlled (80 degrees C, 60 seconds) or voltage-controlled (20 V, 60 s) mode. Electrophysiologic parameters in both groups during radiofrequency lesioning were registered. Observed differences between electrodes were quantified and interpreted, using lesion-size data from egg-white experiments.


RESULTS
Seventeen patients in the temperature group were treated with a total of 55 radiofrequency lesions, all considered technically adequate. In the voltage-controlled group, 16 patients received 63 lesions. Of these, 44 (69.8%) procedures were found to be technically inadequate. Voltage-controlled radiofrequency lesioning resulted in uncontrollable fluctuations of temperature, with resultant uncontrollable variations in lesion size. Temperature-controlled mode created reproducible lesion sizes.


CONCLUSIONS
There is no consistent relation between voltage and the temperature obtained during radiofrequency lumbar facet denervation. Temperature-controlled radiofrequency lesioning is preferred to create reproducible lesion sizes.
Buijs
Evert J
EJ
Centre for Perioperative Medicine, Anesthesiology, and Pain Clinic, University Medical Centre Utrecht, Utrecht, The Netherlands. ejbuijs@kabelfoon.nl
van Wijk
Roelof M A W
RM
Geurts
Jos W M
JW
Weeseman
Rolf R
RR
Stolker
Robert J
RJ
Groen
Gerbrand G
GG
D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D003714:Denervation / Q000379:methods*; D004566:Electrodes; D004594:Electrophysiology / Q000379:methods; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D017116:Low Back Pain / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000294:innervation* / Q000601:surgery; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D015203:Reproducibility of Results; D013696:Temperature; D013997:Time Factors; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000294:innervation* / Q000601:surgery*