经皮脉冲高频疗法治疗颈腰椎神经根疼痛一百五十四个概要课件

Percutaneous Pulsed Radiofrequency in the Treatment of Cervical and Lumbar Radicular Pain Experiences of 154 Patients經皮脈衝高頻療法治療頸腰椎神經根疼痛一百五十四個病人的經驗 趙紹清醫師,鄒錫凱醫師,沈炯祺主任 台中榮民總醫院神經外科 PercutaneousPulsedRadiofrequ1Introduction of Pulsed RFnPreciseanatomiclocationsnBrief“pulses”ofhigh-voltage,radiofrequencyrangeelectricalcurrentnNottoproduceaheatlesionabove45CnProduceanalgesiawithoutproducingdestructionofnervesnPainreliefcausedbycellularchangesinducedbymagneticfields,nottissuedestructionbyheatnNeuromodulation,notneuroablationnSuccessinreducinganumberofdifferentchronicpainstatesinpasttenyearsIntroductionofPulsedRFPreci2LumbarHIVDwithradiculopathy6months(N=108)6%)patients,theprocedurewassuccessful(painreductionmorethan50%)andlastedonaverage3.81%)aftercervicalandlumbarpulseradiofrequencystimulationhadpainrelief50%atthefollow-upperiodofsixmonths.3months(N=116)Thispaperreportstheresultsofaclinicalauditofthefirstconsecutive18patientswithintractablecervicobrachialgiaandwhoweretreatedwithPRFofthecervicaldorsalrootganglion.SluijterME.*Theimprovementwasdefinedaspatientwhohasthepainrelief0;Thesatisfactionwasdefinedaspatientwhohasthepainrelief50%CohenSP,FosterA.SignificantreductionwasfoundintheVisualAnalogScaleforpainfromanaverageof8.趙紹清醫師,鄒錫凱醫師,沈炯祺主任IntroductionofPulsedRFDiscAnInitialReport,PainPractice,Volume5,Issue2,2005111115Theroleofradiofrequencyinfailedbacksurgerypatients.Previousfailedcervicalsurgery1year(N=7)ShahRV,RaczGB.14%)and10in43numbers(23.Reports on MidlinenMunglaniR.Thelongertermeffectofpulsedradiofrequencyforneuropathic pain.Pain1999;80:4379.nVanZundertJ,BrabantS,VandeKelftE,VercruyssenA,VanBuytenJP.PulsedradiofrequencytreatmentoftheGasserianganglioninpatientswithidiopathic trigeminal neuralgia.Pain2003;104(3):44952.nVanZundertJ.,PercutaneousPulsedRadiofrequencyTreatmentoftheCervicalDorsalRootGanglionintheTreatmentofChronic Cervical Pain Syndromes:AClinicalAudit,Neuromodulation,Volume6,Number1,2003614nGeurtsJW,vanWijkRM,WynneHJ,HamminkE,BuskensE,LousbergR,etal.Radiofrequencylesioningofdorsalrootgangliaforchronic lumbosacral radicular pain:arandomised,doubleblind,controlledtrial.Lancet2003;361(9351):216.nMikeladzeG,EspinalR,FinneganR,RoutonJ,MartinD:Pulsedradiofrequencyapplicationintreatmentofchronic zygapophyseal joint pain.SpineJ2003;3:3602nCohenSP,FosterA.Pulsedradiofrequencyasatreatmentforgroin pain and orchialgia.Urology2003;61:45.nSluijterME.Theroleofradiofrequencyinfailed back surgerypatients.CurrRevPain2000;4:4953.nShahRV,RaczGB.Long-termreliefofposttraumatic headachebysphenopalatineganglionpulsedradiofrequencylesioning:acasereport.ArchPhysMedRehabil2004;85(6):10136.nTeixeiraA,GrandinsonM,SluijterME.PulsedRadiofrequencyforRadicular PainDuetoaHerniatedIntervertebralDiscAnInitialReport,PainPractice,Volume5,Issue2,2005111115LumbarHIVDwithradiculopathy3Reports on MidlinenThisisaretrospectiveanalysison114PatientswithachiefcomplaintofaxialcervicalorlumbarpainandwhodeniedradicularsymptomsweretreatedwithPRF.In68(68/114,59.6%)patients,theprocedurewassuccessful(painreductionmorethan50%)andlastedonaverage3.931.86months.MikeladzeG,EspinalR,Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain.Spine J 2003;3:3602nThispaperreportstheresultsofaclinicalauditofthefirstconsecutive18patientswithintractablecervicobrachialgiaandwhoweretreatedwithPRFofthecervicaldorsalrootganglion.Satisfactorypainreliefofatleast50%wasachievedin13of18(72%)patientsatpost-operation8weeks.Morethanoneyearaftertreatment,6patients(33%)continuetoratetreatmentoutcomeasgoodorverygood.VanZundertJ.,Percutaneous Pulsed Radiofrequency Treatment of the Cervical Dorsal Root Ganglion in the Treatment of Chronic Cervical Pain Syndromes:A Clinical Audit,Neuromodulation,Volume6,Number1,2003614ReportsonMidlineThisisare4ProduceanalgesiawithoutproducingdestructionofnervesVisualanalogpainscaleLumbarHIVDwithradiculopathyArchPhysMedRehabil2004;85(6):10136.Theroleofradiofrequencyinfailedbacksurgerypatients.Theroleofradiofrequencyinfailedbacksurgerypatients.Radiofrequencylesioningofdorsalrootgangliaforchroniclumbosacralradicularpain:arandomised,doubleblind,controlledtrial.9months(N=21)(L5)112VisualanalogpainscaleSpineJ2003;3:3602Reports on MidlinenThisisaretrospectivestudyon13consecutivepatientswithradicularpain,duetoaherniatedintervertebraldisc,atlevelsL3toS1.AllweretreatedwithPRFoflumbardorsalrootganglion.Thenumericratingscale(NRS)scorefellfrom7.83to2.25overthefirst2weeks.TeixeiraA,Pulsed Radiofrequency for Radicular Pain Due to a Herniated Intervertebral Disc An Initial Report,Pain Practice,Volume5,Issue2,2005111115nThisstudyreportstheresultofpulsedRFin28patientssufferingfromsevereradicularpaintreatedbypulsedRF.Therewere20casesoflowbackpainand8withneckpain.Thefirstfollow-upafter3monthsrevealedthefollowingresults:excellentresultsin2cases(7.1%),goodresultsin12cases(42.9%),fairin9(32.1%)andunresponsivenesstotreatmentin5(17.9%).SignificantreductionwasfoundintheVisualAnalogScaleforpainfromanaverageof8.8to4.2after3months,4.8after6monthsand4.9after1year.PevznerE;DavidR;LeitnerY,Pulsed radiofrequency treatment of severe radicular pain,Harefuah,2005Mar;Vol.144(3),pp.178-80,231.Produceanalgesiawithoutprod5Patient selectionnWecollected154caseswithachiefcomplaintofcervicalorlumbarradicularpainduetoaherniatedintervertebraldiscorpreviousfailedsurgery,fromSeptember2004toOctober2005nFollow-upperiodwasfromoneweektooneyearpostoperatively.nThereare71maleand83femalepatients.nThemeanpreoperativevisualanalogpainscaleofpatientswhohadcervical,lumbarradicularpainwere67.5514.37,65.5216.44(0-100).PatientselectionWecollected6Table1.Thedemographicandclinicalfeaturesof154patientsCervical(N=49)Lumbar(N=116)Total(N=165)Malerange1732-765826-9275Femalerange3239-795831-8890Age(years,mean SD)53.2010.9962.4213.16Visualanalogpainscale(0-100,mean SD)67.5514.3765.5216.44Table1.Thedemographicandc7Cervical(n=49)Lumbar(n=116)Nerveroots(C3)3(L3)18(C4)40(L4)95(C5)49(L5)112(C6)30(S1)19(C7)2DiseaseclassificationCervicalHIVDwithradiculopathy44Previousfailedcervicalsurgery5LumbarHIVDwithradiculopathy88Failedbacksurgerysyndrome28TreatmentsideRt.2966Lt.2050Table2.ThetreatmentlevelsanddiseaseclassificationCervical(n=49)Lumbar(n=116)8*Theimprovementwasdefinedaspatientwhohasthepainrelief0;Thesatisfactionwasdefinedaspatientwhohasthepainrelief50%1week(N=49)1month(N=49)3months(N=49)6months(N=40)9months(N=21)1year(N=7)worse0000000%10101415730&50%139832050=&0;Thesatisfactionwasdefinedaspatientwhohasthepainrelief50%1week(N=116)1month(N=116)3months(N=116)6months(N=108)9months(N=58)1year(N=43)worse0000000%2126344828200&50%36343017141350=&10051443932117100%812131153Improvementrate(%)*81.9077.5970.6955.5651.7253.49Satisfactoryrate(%)*50.8648.2844.8339.8127.5923.26Table4.Resultsafterlumbarpulsedradiofrequencystimulation*Theimprovementwasdefineda12Figure3.Figure3.13Figure4.Visualanalogpainscaledistributiononlumbarpatientswithimprovement 50%andlastformorethan1monthFigure4.Visualanalogpains14Resultsn30in49numbers(61.22%)and56in116numbers(48.28%)aftercervical,andlumbarpulseradiofrequencystimulationhadtheinitialimprovement50%inthefirstmonthfollowup.n22in40numbers(55.00%)and43in108numbers(39.81%)aftercervicalandlumbarpulseradiofrequencystimulationhadpainrelief50%atthefollow-upperiodofsixmonths.nAfteroneyearfollowup,4in7numbers(57.14%)and10in43numbers(23.26%)aftercervicalandlumbarpulseradiofrequencystimulationhadthepainreliefeffect50%.Results30in49numbers(61.2215ConclusionnTheresultsofthisretrospectiveanalysisshowedthattheapplicationofpulsedradiofrequencyisasafeandusefulinterventionforcervicalandlumbarradicularpain(approximatelyoneyear).nAlthoughpulsedradiofrequencyappearstoprovideintermediate-termreliefofpain,furtherstudieswithlong-termfollow-uparenecessary.ConclusionTheresultsofthis16 Thank you for your attention Thankyouforyourattention17经皮脉冲高频疗法治疗颈腰椎神经根疼痛一百五十四个概要课件18