Radiofrequency Techniques

Radiofrequency Techniques

Pulsed Radiofrequency, Lumbar Sympathectomy, Radiofrequency Rhizolysis.

Radiofrequency Techniques

Pulsed Radiofrequency, Lumbar Sympathectomy, Radiofrequency Rhizolysis.

Radiofrequency Treatment of Trigeminal Neuralgia (Radiofrequency Thermocoagulation of Gasser's Ganglion)

Trigeminal neuralgia is one of the most intense pains that can be experienced. It is characterized by the appearance of pain in the facial region, of great intensity, and with characteristics of spasm or electric current, which persists for a few seconds or even minutes. There are forms of this disease that can produce permanent pain throughout the day. These crises are sometimes triggered by minimal stimuli, such as talking, chewing, brushing teeth or shaving. The pain is very difficult to bear and is often accompanied by a great deterioration in the quality of life of the sufferer.

When pharmacological treatment with specific drugs is not effective, it is necessary to consider the use of minimally invasive techniques. The most widely used at present, as well as the one with the highest success rate, with a lower incidence of adverse effects, is the Thermocoagulation of the Ganglion of Gasser with Radiofrequency. It consists of introducing a special cannula through the cheek, directed by radioscopic guidance to the trigeminal nerve ganglion (Gasser’s ganglion), which is located at the base of the skull. Once the cannula is positioned, radiofrequency treatment is performed, producing a controlled thermocoagulation of small portions of the ganglion, which will result in the disappearance of pain. The procedure is performed in the operating room under sedation and does not require hospitalization.

Glossopharyngeal neuralgia is a rare painful condition of unknown cause. It produces a constant pain with crises in the region near the tonsils and the pharynx and ear. Pulsed Radiofrequency treatment of the glossopharyngeal nerve is used in cases where all pharmacological treatments have failed. It is performed by inserting a small radiofrequency cannula in the lateral region of the neck, behind the ear, until it contacts the glossopharyngeal nerve. After that, a pulsed radiofrequency current is applied for several minutes at low temperature. Good results can be obtained after a few days.

It is used in the treatment of certain facial neuralgias, as well as in certain types of headache, such as the so-called cluster headache, Horton’s headache or cluster headache. It can also be used in other vascular headaches such as migraine, or in chronic paroxysmal headache when they do not respond to pharmacological treatment.

In some patients pain persists after surgery, or pain appears in the intervened areas. This pain is probably of neuropathic origin, and is often difficult to treat. Examples are pain after inguinal hernia surgery or plastic surgery. It also occurs in cases of fractures that have produced adhesions or have left sequelae. In these cases, it is common to see how reintervention does not solve the problems, or can even aggravate them, creating new scars and more neural irritation.

Good results have been obtained with the application of pulsed radiofrequency. It is performed under sedation and does not require open intervention, but the insertion of one or more cannulas. The results can be seen after a few days, and usually persist for several months, or even be definitive.

Currently the treatment of carpal tunnel syndrome or median nerve neuropathy can be performed without surgery. Through the use of Dual Pulsed radiofrequency optimal results are obtained and maintained for a long time. The technique is innocuous, does not require any surgical incision or subsequent rehabilitation, and can be repeated as many times as necessary. It does not require prolonged rest, and the patient can return to normal activity after 48 hours or even sooner.

It is performed in the operating room under sedation, and involves the introduction of two small radiofrequency cannulas that are placed in the proximity of the median nerve in the wrist, to perform stimulation by means of pulsed radiofrequency. This is a type of treatment first described by Dr. Ricardo Ruiz-López, the results of which have been published in leading scientific journals.

  • Treatment of median nerve compression with pulsed radiofrequency: Preliminary results in 25 cases. Ruiz-Lopez R. Descarregar
  • Description of a new minimally invasive approach of the median nerve in the carpal tunnel. Ruiz-Lopez R. Descarregar

Complex Regional Pain Syndrome (CRPS) is a chronic pain disorder usually affecting one limb. It is believed to be caused by a dysfunction of the central or peripheral nervous system, usually after one or more trauma, or surgical interventions. When the pain is due to a lesion in the nervous system, then it is called Causalgia. The clinical features are: intense pain, often continuous, which appears to be disproportionate to the existing injury, or lasts longer than expected, changes in skin color and temperature in the affected body part, changes in sensitivity of the affected area, swelling and stiffness, hypersweating and changes in hair or nail growth on the affected limb, decreased ability to move the affected body part. Frequently the pain extends to the entire limb and to places distant from the original lesion.

The quality of life of sufferers is usually greatly affected, and is often accompanied by depressive or anxiety symptoms.

Causes of CRPS

The ultimate cause by which CRPS develops after trauma or surgery is unknown. However, it appears that the Sympathetic Nervous System plays an important role in the maintenance of pain. Studies seem to indicate that adrenaline, a catecholamine released by the sympathetic nervous system, acquires the ability to activate pain transmission pathways following tissue or peripheral nerve injury. CRPS most likely does not have a single cause, but is the result of several factors that condition the onset of the disease.

Diagnosis of CRPS

The diagnosis is eminently based on symptomatology. It must be confirmed and documented by complementary explorations such as X-rays, three-phase bone scintigraphy and infrared telethermography.

Prognosis of CRPS

The prognosis is variable, although it generally depends on the chronicity of the process and early treatment. In some people the symptoms disappear spontaneously. In others the pain may be chronic, continuous, and accompanied by irreversible and disabling changes, despite treatment.

Treatment of CRPS

Treatment should be multidisciplinary, including intensive physical therapy and pharmacological treatment.

In cases that do not respond to treatment, Radiofrequency Sympathectomy can be performed. This treatment consists of interrupting nerve conduction in the sympathetic chain, either at the cervical level when the problem affects the upper extremities, or at the lumbar level when the pain is located in the lower extremity. Prior to treatment, a block will be performed for diagnostic and prognostic purposes.

The sympathetic chain block consists of the injection of local anesthetics into the sympathetic chain, followed by a period of observation to verify the response. The sympathetic block technique is performed in a fully equipped operating room with fluoroscopy and with the patient sedated. Hospital admission is not necessary and the patient can go home after one or two hours.

If the block is positive, i.e., effective in relieving pain for a certain period of time, sympathetic chain sympathectomy by radiofrequency is performed. The technique is similar to the one used for the block, but in this case Radiofrequency cannulas will be used, in order to produce a coagulation that blocks the nerve conduction. This is an outpatient technique that can be performed under sedation and local anesthesia.

Other therapeutic options for the treatment of CRPS are spinal cord stimulation and spinal drug infusion with an implantable pump.

The cervical spine rhizolysis or cervical facet denervation by radiofrequency is a technique used to treat pain caused by problems in the joints of the cervical spine.

Radiofrequency is a type of electrical energy through which many types of medical treatments are performed. In the case of cervical rhizolysis, the aim is to thermocoagulate the nerve endings in order to neutralize the transmission of pain, without affecting the tactile or motor function. The cervical spine has in the posterior part some small joints called zygapophyseal joints or posterior joints. These joints can suffer from various disorders such as osteoarthritis or inflammation and deformity, and can be very painful. These joints have nerve endings that conduct the sensation of pain. If we raise the temperature of these nerve endings, pain conduction will be largely blocked for a prolonged period of time. The treatment is performed with great precision, so that only a few nerve fibers, responsible for pain transmission, are injured. The other types of nerve fibers remain intact, so the motor function or sensitivity of the upper extremities will not be affected.

The technique will be performed in the operating room. Before starting, you will receive intravenous sedation. Radiological control will locate the exact points that need to be treated. Local anesthesia will be injected, and then several very fine caliber cannulas will be introduced, especially for radiofrequency, whose tip is an electrode, and with them the neural lesion will be performed in the place we are interested in.

The procedure is ambulatory, so patients can go home after a little more than an hour. It is common to feel some discomfort at the puncture site after the procedure, for which analgesic medication may be prescribed.

Radiofrequency dorsal spine rhizolysis or dorsal facet denervation is a technique used to treat back pain caused by problems in the posterior joints of the dorsal spine.

Radiofrequency is a type of electrical energy through which many types of medical treatments are performed. In the case of dorsal Rhizolysis, the aim is to thermocoagulate the nerve endings in order to neutralize the transmission of pain, without affecting the tactile or motor function at all. The dorsal spine has small joints in the posterior part called zygapophyseal joints or posterior joints. These joints can suffer from various disorders such as osteoarthritis or inflammation and deformity, and can be very painful. These joints have nerve endings that conduct the sensation of pain. If we raise the temperature of these nerve endings, pain conduction will be largely blocked for a prolonged period of time. The treatment is performed with great precision, so that only a few nerve fibers, responsible for pain transmission, are injured. The other types of nerve fibers remain intact, so motor function or sensitivity will not be affected.

The technique will be performed in the operating room. Before starting, you will receive intravenous sedation. Radiological control will locate the exact points that need to be treated. Local anesthesia will be injected, and then several very fine caliber cannulas will be introduced, especially for radiofrequency, whose tip is an electrode, and with them the neural lesion will be performed in the place we are interested in.

The procedure is ambulatory, so patients can go home after a little more than an hour. It is common to feel some discomfort at the puncture site after the procedure, for which analgesic medication may be prescribed.

Lumbar spine rhizolysis or lumbar facet denervation by radiofrequency is a technique used to treat lumbar pain. This pain, in a high percentage of cases, is caused by problems in the joints of the lumbar spine.

Radiofrequency is a type of electrical energy used in many types of medical treatments. In the case of lumbar Rhizolysis, the aim is to thermocoagulate the nerve endings in order to neutralize the transmission of pain, without affecting the tactile or motor function at all. The lumbar spine has small joints in the posterior part called zygapophyseal joints or posterior joints. These joints can suffer from various disorders such as osteoarthritis or inflammation and deformity, and can be very painful. These joints have nerve endings that conduct the sensation of pain. If we raise the temperature of these nerve endings, pain conduction will be largely blocked for a prolonged period of time. The treatment is performed with great precision, so that only a few nerve fibers, responsible for pain transmission, are injured. The other types of nerve fibers remain intact, so the motor function or sensitivity of the lower extremities will not be affected.

The technique will be performed in the operating room. Before starting, you will receive intravenous sedation. Radiological control will locate the exact points that need to be treated. Local anesthesia will be injected, and then several very fine caliber cannulas will be introduced, especially for radiofrequency, whose tip is an electrode, and with them the neural lesion will be performed in the place we are interested in.

The procedure is ambulatory, so patients can go home after a little more than an hour. It is common to feel some discomfort at the puncture site after the procedure, for which analgesic medication may be prescribed.

The neurons that pick up pain sensitivity are grouped in a small structure called the “Dorsal Root Ganglion”, which is located along the entire spinal column in the foramina of the spinal cord through which the spinal nerves exit. From this nerve ganglion, sensitivity is sent to the spinal cord and brain.

For years, pain radiating to the lower extremities or sciatica has been effectively treated by pulsed radiofrequency stimulation of the dorsal root ganglion at various levels of the lumbar and sacral spine.

Pulsed radiofrequency is a radiofrequency modality that allows higher voltages of electricity to be administered to a tissue without raising the temperature of the tissue. It involves the stimulation of an anatomical region by means of electric fields without causing lesions or burns, since the temperature applied never exceeds 42ºC.

The procedure is performed under local anesthesia and mild intravenous sedation. You will be placed face down on a stretcher and a venous line will be placed through which antibiotics and sedatives will be administered, so that you are comfortable and relaxed throughout the procedure.

The location of the dorsal root ganglion at the various levels to be treated is located by radiology. It is performed under local anesthesia. Once the radiofrequency cannula is placed in the precise location, it is connected to an electrode through which electrical stimulation tests can be performed to confirm the correct location, and then the pulsed radiofrequency treatment is administered for several minutes, during which no discomfort is felt.

At the end of the treatment, corticoids and sometimes anesthetics and hyaluronidase are injected to promote early improvement. Discharge usually takes place after a few hours. The results of this treatment usually take about two to three weeks.

When this technique is performed with all the guarantees of safety, there is practically no risk of complications.

However, cases have been described in which local or epidural infections or bleeding have occurred, requiring specific treatment. Exceptionally, there have also been cases of arterial lesions resulting in spinal cord damage. All these complications are extremely rare, especially if all precautions are taken.

Intervencionismo del Dolor Clínica Vertebra Barcelona Madrid

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Patient Reviews

After months of intense pain in my back and leg due to a hernia, and after being full of medications and rehabilitation sessions, finally a friend recommended this clinic and I was absolutely right. They visited me very quickly and Dr Ruiz performed a radiofrequency intervention that has solved the problem, it no longer hurts and I have regained my quality of life, which I had lost. I only have words of gratitude

Pedro L., See original review on Google

I had a rhizolysis two years ago and it is the best decision I ever made. I was advised to go to this clinic. Excellent staff and treatment. I would come back without hesitation. I am a different person since I don’t feel any pain.

Pepy A., See original review on Google

In a frankly desperate situation with my mother suffering from trigeminal neuralgia and with continuous and terrible pain during confinement and no public health doctor able to relieve her pain in any way, it was miraculous to find this center by surfing the internet. In just a couple of weeks after the initial visit, Dr. Ruiz operated on my mother in an outpatient and non-aggressive surgery and in just a few days she regained speech, mobility and finally began to sleep as she no longer suffered the tremendous pain. And if the treatment has been effective thanks to the hands of a great doctor, this does not mean that the whole team at the center is not deserving of credit. From the reception to the nurses, they are all exemplary professionals who make you feel safe and in good hands at all times. My mother is already another and just 4 months later we are aware that there is no better investment than health and Clínica Vértebra is a success. Totally recommendable. THANKS A MILLION.

icono pacientes 3Alicia R., See original review on Google

It has been a long time since I felt what it was like to live without pain. I only have words of gratitude for the whole team, from the reception staff to the operating room team. Thank you Dr. Squarcia for such a detailed explanation of my problem and for the accuracy of the treatment. I pray to God that this wellness lasts for a long time.

icono pacientes 4Alicia G., See original review on Google

I had a lumbar facet denervation (Rhizolysis) this morning and I have to say that «O» pain. It has been 10 hours since the intervention and I am still without any pain and without medication. Congratulations to the whole team. Viggo Adeler (Physician)

icono Viggo Adeler, See original review on Google

Good treatment and attention, I went with a horse sciatica and they left me like new, I only have words of thanks.

icono pacientes 2Antonio R., See original review on Google

It is a place that has improved my quality of life.

icono Markus O., See original review on Google

I only have words of thanks to Doctors Ricardo Ruiz and Dr. Matias, I have gone to them twice, and I only have words of thanks, they have solved my problem, first of Lumbar vertebrae and the second of a shoulder, and in both cases total success, I have not returned to have any kind of discomfort, I am totally grateful to them, they have changed my life. THANK YOU DOCTORS, you are fantastic.

Juan J., See original review on Google

First visit with Dr. Mattia Squarcia, finally a doctor who listens to me and looks at all my medical tests. I have already had a bad experience with another pain clinic where the doctor did not listen to me and did not even look at a single medical test.

Anabel R., See original review on Google

I have only words of thanks, thank you Doctor Ricardo Ruiz.

Carlos, See original review on Google