电刺激治疗术后截瘫课件

按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,Application of Radiofrequency in Failed Back Surgery Syndrome(with video presentation),Wei Gong Memorial Hospital,Chao-Jan Wang/,王超然,M.D.M.S.,Wei Gong Memorial Hospital,財團法人為恭紀念醫院,Stereotactic Cingulotomy for Cancer Pain,Instability of lumbar spine surgery:,What is“Spine Man?,Tx:,Spinal surgical disease,or,Spinal disease,Treatment of spinal disease:,The indication?,Spinal structure neural tissue,surgery Pain control,Strategy of FBSS(I):,FBSS(Failed Back Surgery Syndrome),Without radiculopathy,surgery,With radiculopathy,L2 Pulsed,radiofrequency,Epidural Injection,Procedure,Neural,compression,Re-open surgery,Imaging,Studies,Pulsed,radiofrequency,Sympathetic Block,Imaging Studies,IDET(Discogram),Facet,Denervation,NCV/EMG,Mapping,Pulsed,radiofrequency,IDET,Spinal Cord Stimulation,Post,Multi-operation,Detail Spinal Surgical History,Strategies of FBSS(2):,Lesion Radiofrequency,Lumbar Facet Denervation,IDL or IDET,Pulsed Radiofrequency,Lumbar DRG stimulation,Therapeutic Diagnosis of Failed Back Surgery Syndrome With Lumbar Facet Denervation,(Video Presentation ),Lumbar Facet Syndrome Pain Referral Map:,Lumbar X ray&CT finding in FBSS,Radiographic evidence:,equivocal utility.,May be narrowing of the,interbody disc space,and the,painful level.,If the patient has had a lumbar fusion,common to develop facet joint pain,above,the fusion level.,The patient has had,disectomy,causing increasing pressure on the facet joint,at that level.,Diagnose,Through a diagnostic block,But:False positives,Case number,Initial outcome,(,improved rate),3,months,F/U,6,months F/U,Failed back syndrome,26,12,(46%),6,(23%),2,(8%),Results of Facet Denervation in FBSS,:,2003/01/01-2003/12/31.,Conclusion,Lumbar percutaneous facet denervation offers a minimally invasive therapeutic diagnosis for sufferers of failed back surgery syndrome.,The efficacy of facet denervation for previous lumbar surgery?,DRG pulsed radiofrequency,Inspired:,1999,Rajesh Munglani,The longer effect of pulsed radiofrequency for neuropathic pain,Pain 80,p437-439.,4 cases suffered FBSS treated with Pulsed Radiofrequency :,Followed up:7 months,6 months,1 month ,2 months.,All of them revealed excellent outcome.,1997,Robert Slappendel et al,.“The efficacy of radiofrequency lesion of the cervical spinal dorsal root ganglion in a double blinded randomized study:,no difference,between 40,C and 67 C treatment,.“,Pain 73 p159-163,Amplitude,Amplitude,OFF,ON,Difference in Amplitude for Continuous RF and Pulsed RF,ON,Application field:,Facet syndrome,Failed back syndrome.,Stellate ganglion block,Neuropathic pain,DM with neuropathy(?),Herpes Zoster with neuropathy.,Mild to Moderate CTS,Parathropathy of the knee,hip,Insertion myotendinosen at the iliac crest,Primary and secondary intercostal neuralgia,Peripheral neuralgia sensory nerve,Occiptal neuralgia,Trigeminal neuralgia,Neuroma conditioned pain syndrome,Multiple Sclerosis,Coccygodynia,Postdiscetomie syndrome,Sympathetic conditioned pain,RF lesion adjacent to the dorsal root lesion only transient sensory loss in the relevant dermatome,pain relief may be of much longer duration.,A selective action of heat on,unmyelinated C-fibers,but could not be corroborated by pathological studies,.(,1981,Smith HP,J Neurosurg,),Mechanism:,Mechanism:,Delivering an EMF,without,producing neurodestructive heat:,Maximal,tip temperative of,42,C,.,Can be applied in a,pulsed,fashion.,.(,1981,Smith HP,J Neurosurg,),The electric field:,Large E-field,rise to large differential electric field stress on,membranes and molecules,within the nerve cells.,cause,permanent configurational changes,:including destruction of membranes and molecular chains,then they could have major effects on cell function.Such effects may vary in degree from myelinated to unmyelinated structures because of the capacitive character of the myelin sheath.(,1998,Menno.Sluijer et al,The Pain Clinic),PULSED RF:,ADVANTAGES,The PRF procedures are not neuro destructive nor do they produce temporary sensory deficit,It can be used in neuropathic pain,Less discomfort after the procedure,Can be used where conventional RF is“forbidden,CASE I,General data,Sex:male,Age:52 years,Chief complain:,Severe low back pain with soreness with bilateral lower limbs weakness for years and accepted surgical intervention in 2003,February.But the symptom persistently existed after surgery.,Case number,Initial outcome,(improved rate),3,months,F/U,6,months,F/U,Chronic low back pain,(,lumbar facet syndrome,&discogenic pain),40,36,(90%),23,(56%),20,(40%),Failed back syndrome,22,18,(82%),10,(45%),6,(27%),Results of Pulsed Radiofrequency,:,2003/01/01-2003/12/31.,Conclusion1:,The pulsed radiofrequency can apply to functional nerve,highly selective block,C fiber,long term duration and preserve motor fiber.,An,effective,safety,and,minimal invasive,therapy to patients who suffered,intractable spinal and neuropathic pain including FBSS.,Conclusion2,Chronic lumbar spinal pain(with surgery),Po