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Trivedi R, deJong JL, Hansma PA. Sudden Death Due to Necrotizing Fasciitis After Routine Cervical Radiofrequency Ablation Treatment. Am J Forensic Med Pathol 2024:00000433-990000000-00207. [PMID: 39018438 DOI: 10.1097/paf.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
ABSTRACT Cervical facet joint neurotomy, also known as cervical radiofrequency ablation (RFA) or cervical facet rhizotomy, is a medical procedure aimed at alleviating chronic neck pain caused by issues related to the cervical facet joints through ablation of neurons (J Pain Res 2021;14:2807-2831). Although generally safe, adverse events can occur. Infection is a rare consequence of this procedure. Most injection-site infections related to cervical RFA occur spontaneously and resolve with oral antibiotics without sequelae (World Neurosurg 2018;111:e644-e648). We report a case in which a cervical RFA injection resulted in the development of necrotizing fasciitis and ultimately death. To our knowledge, this has not been previously reported and is the first documented fatality due to infectious sequelae of a cervical RFA procedure.
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Affiliation(s)
- Ravi Trivedi
- From the Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
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Candan B, Gungor S. Traditional versus cooled-radiofrequency neurotomy for the treatment of chronic lumbar facet (zygapophyseal) joint pain. Pain Manag 2024; 14:305-314. [PMID: 39076116 PMCID: PMC11340768 DOI: 10.1080/17581869.2024.2377061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 07/03/2024] [Indexed: 07/31/2024] Open
Abstract
Aim: Traditional radiofrequency ablation (TRFA) effectively treats facet joint-related pain, while water-cooled radiofrequency ablation (CRFA) may offer benefits like larger lesions and easier nerve access. Our goal is to assess the effectiveness of TRFA and CRFA for facet joint-related pain.Materials & methods: This retrospective study included an evaluation of 346 RFA interventions performed on 190 patients suffering from long-term low-back pain. The primary outcome was defined as a decrease of ≥50% of the mean numeric rating scale.Results: The primary outcome was achieved at the first follow-up (FU) for both TRFA and CRFA, with pain relief of 55.2 and 60.5%, respectively. At the second FU, the primary outcome was achieved only in the CRFA group (54.1%), although the TRFA group also showed a good improvement (48.6%). In both groups, pain relief was under 50% during the third FU.Conclusion: Our study indicates that both CRFA and TRFA modalities are effective and safe treatments.
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Affiliation(s)
- Burcu Candan
- Division of Musculoskeletal & Interventional Pain Management, Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, NY 10021, USA
| | - Semih Gungor
- Division of Musculoskeletal & Interventional Pain Management, Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, NY 10021, USA
- Department of Anesthesiology, Weill Cornell Medicine, NY 10021,USA
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Dinesh N, Gupta R, Lall D, Jain A. Cooled radiofrequency ablation of cervical medial branches for treatment of facetogenic pain. INDIAN JOURNAL OF PAIN 2022. [DOI: 10.4103/ijpn.ijpn_87_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tieppo Francio V, Barndt B, Eubanks J, Smith M. Third-degree full-thickness burns as a complication of cervical radiofrequency ablation. BMJ Case Rep 2021; 14:e245113. [PMID: 34848408 PMCID: PMC8634204 DOI: 10.1136/bcr-2021-245113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/03/2022] Open
Abstract
A 46-year-old woman underwent a cervical radiofrequency ablation (RFA) for chronic neck pain. Following the procedure, two areas surrounding the grounding pad in the lumbar region developed full thickness third-degree burns. Burn injuries following cervical RFA are rarely reported and are most often associated with cardiac and solid tumour RFA. Only one other case has been reported in literature with a similar outcome following a thoracic facet RFA. In our case, the lesion was directly from the ground pad and not from the radiofrequency electrode, which is more often the culprit. This is the first case reported in the literature of a full-thickness skin burn from a cervical RFA. Physicians should be aware of the potential for severe burns around the RF probe and ground pad as sequelae of RFA, and we caution the use of sedation during the procedure, as patients will unlikely be able to report any unusual sensation.
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Affiliation(s)
| | - Brandon Barndt
- Physical Medicine and Rehabilitation, Temple University, Philadelphia, Pennsylvania, USA
| | - James Eubanks
- Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - McCasey Smith
- Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Lee DW, Pritzlaff S, Jung MJ, Ghosh P, Hagedorn JM, Tate J, Scarfo K, Strand N, Chakravarthy K, Sayed D, Deer TR, Amirdelfan K. Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN). J Pain Res 2021; 14:2807-2831. [PMID: 34526815 PMCID: PMC8436449 DOI: 10.2147/jpr.s325665] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/21/2021] [Indexed: 01/02/2023] Open
Abstract
Radiofrequency neurotomy (RFN), also known as radiofrequency ablation (RFA), is a common interventional procedure used to treat pain from an innervated structure. RFN has historically been used to treat chronic facet-joint mediated pain. The use of RFN has more recently expanded beyond facet-joint mediated pain to peripherally innervated targets. In addition, there has also been the emergence of different radiofrequency modalities, including pulsed and cooled RFN. The use of RFN has been particularly important where conservative and/or surgical measures have failed to provide pain relief. With the emergence of this therapeutic option and its novel applications, the American Society of Pain and Neuroscience (ASPN) identified the need for formal evidence-based guidance. The authors formed a multidisciplinary work group tasked to examine the latest evidence-based medicine for the various applications of RFN, including cervical, thoracic, lumbar spine; posterior sacroiliac joint pain; hip and knee joints; and occipital neuralgia. Best practice guidelines, evidence and consensus grading were provided for each anatomical target.
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Affiliation(s)
- David W Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, 92831, USA
| | - Scott Pritzlaff
- University of California, Davis.,Division of Pain Medicine, Sacramento, CA, USA
| | - Michael J Jung
- University of California, Davis.,Division of Pain Medicine, Sacramento, CA, USA
| | | | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jordan Tate
- Alliance Spine and Pain Centers, Canton, GA, USA
| | - Keith Scarfo
- Warren Alpert Medical School of Brown University Department of Neurosurgery - Norman Prince Spine Institute, Rhode Island Hospital, Providence, RI, USA
| | - Natalie Strand
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Dawood Sayed
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Inc., Charleston, WV, USA
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