Korean J Pain.  2014 Jan;27(1):43-48. 10.3344/kjp.2014.27.1.43.

Bipolar Intra-articular Radiofrequency Thermocoagulation of the Thoracic Facet Joints: A Case Series of a New Technique

• Kim D

• KMID: 2278201
• DOI: http://doi.org/10.3344/kjp.2014.27.1.43

Abstract

BACKGROUND
This study tests the hypothesis that of bipolar radiofrequency thermocoagulation of the thoracic facet joint capsule may provide a safe and effect method of pain control from thoracic facet origin.
METHODS
Among patients suffering from localized mid back pain, nine patients with thoracic facet disease confirmed by magnetic resonance image and diagnostic thoracic facet block were enrolled. Bipolar radiofrequency ablation in the inferior aspect of the thoracic facet joint was done. Visual Analog Scale (VAS) was measured pre-intervention and 1 month post-intervention. Any complications and changes in amount of pain medication were recorded.
RESULTS
Significant 47.6% reduction in VAS was noted at 1 month. There were no serious complications.
CONCLUSIONS
Intra-articular bipolarradiofrequency thermocoagulation of the thoracic facet joint may be a technically easier and valid method of treating mid back pain of thoracic facet origin.

Keyword

facet; radiofrequency; thermocoagulation; thoracic

MeSH Terms

Back Pain
Catheter Ablation
Electrocoagulation*
Humans
Methods
Visual Analog Scale
Zygapophyseal Joint*

Figure

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  Fig. 1 Illustration of medial branch (MB) and lateral branch (LB) thoracic spine. Bogduk N (ed). Practice Guidelines for Spinal Diagnostics and Treatment Procedures. International Spine Injection Society (ISIS) 2004. Reproduced with permission of the publishers. PD: pedicle, VB: body of vertebra, SAP: superior articular process, LCL: lateral costovertebral ligament, LC: levator costorum, TP: transverse process, RB: rib, EI: external intercostal muscle, ZJ: zygaphophysial joint, VR: ventral root, SP: spinous process.

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  Fig. 2 Illustration of variation of position of medial branch in thoracic spine. Bogduk N (ed). Practice Guidelines for Spinal Diagnostics and Treatment Procedures,. International Spine Injection Society (ISIS) 2004. Reproduced with permission of the publishers.

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  Fig. 3 Lateral and AP views of bipolar RFTC at left T4-5 and T5-6 facet joints. Note pairs of electrodes side by side approximately 5 mm apart in the inferior aspect of each joint.

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  Fig. 4 Medial branch block T3 and T10 at the lateral end of superior border of the transverse process using opposite oblique orientation to see the superior tip of the transverse process: the "Pinnochio" view. Bogduk N (ed). Practice Guidelines for Spinal Diagnostics and Treatment Procedures. International Spine Injection Society (ISIS) 2004. Reproduced with permission of the publishers.

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  Fig. 5 Medial branch block left T5 above superior aspect of tip of left T6 transverse process. Bogduk N (ed). Practice Guidelines for Spinal Diagnostics and Treatment Procedures. International Spine Injection Society (ISIS) 2004. Reproduced with permission of the publishers.

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