Скачать или смотреть Trailer_ Pulsed radiofrequency treatment for lumbar radicular pain targetting L4,5 roots

It is a case of pulsed radiofrequency at the right L4 and L5 roots for the pain relief of L5 radicular pain.
I will use the Cosman G4 radiofrequency generator, which provides four-channel.
I will skip the basic knowledge about radiofrequency treatment for radicular pain. Instead, please find and review this video.
The radiofrequency cannula consists of a diameter between 18 and 21 G. The shaft is coated with siliconized insulation to offer enhanced lubricity.
But it is more challenging and painful to penetrate the soft tissue than the Quincke type spinal needle.
So, I must anesthetize the skin and soft tissue to acquire patient cooperation in advance. First, let me turn to the ipsilateral oblique view.
I will infiltrate the local anesthetics after marking the skin under C –arm guidance.
Please wait. There is something wrong with the patient's position.
While waiting for the numbing, I will connect the lines to the RF generator.
I will use bipolar mode, So, I need two connection lines.
I already put the ground pad on the body before the procedure.
I begin inserting the RF cannula at the L4 root.
I usually select the 21G, 15 Cm long, curved needle tip type for the lumbar spine.
Unlike the transforaminal injection, I control the needle with my bare hand, and long forceps are only used for assist.
I don’t want to damage the coating of the RF cannula by tough metallic teeth of the long forceps.
I aim to the subpedicular space and could roughly measure the deep penetration depth with AP view.
The next target is the right L5 nerve root.
So, I always begin the L4 root needle insertion first.
Again, I use the long forceps for holding the needle for checking the needle position under x-ray-on.
I move the needle slowly
Would you please give me an AP view?
I will advance the needle toward to 9 o’clock position of the pedicle.
It is a contralateral oblique view showing two cannulae.

I will advance the L4 needle first.

I try to contact the needle to the dorsal root ganglion as close as possible.

I watch the C-arm image and ask the patient’s response constantly.

I will insert the RF electrode into the cannula.
It is an electrode.
I insert the RF electrode into the cannular RF needle.

I will test the L4 nerve root with stimulation mode.

I will increase the voltage of the RF currency to 0.4V.

The purpose of stimulation is to put the needle close to the DRG. It is a monopolar mode.
The electromagnetic current flow from the RF electrode to the ground pad in the monopolar mode.

The electric field magnitude depends on the distance from the electrode.

The electromagnetic current could not affect the nerve root if the electrode is located far from the nerve root.

Therefore, the patient could not notice any sensory change.

The low electromagnetic current could induce severe sensory change such as electric shock if the electrode is too close to the nerve root.

The high voltage electric current can evoke severe electric shock even at the optimal distance between electrode and DRG.

So, 0.4 V is the maximal magnitude in the stimulation mode.

I will move on to the L5 nerve root.

I will increase the range to 0.4V while continuously asking the patient's responses.

And then switch to bipolar mode. I connect a pair of L4 and L5 electrodes in one electric circuit.

The electromagnetic waves are formed around the two active electrodes and interspace in the bipolar mode.
I will increase the voltage gradually.

In a pulsed radiofrequency mode, the temperature is fixed to remain under 42 Celsius.

But I will increase to 55 voltage.

Traditionally, I was supposed to increase the voltage to 45V. The 45 V is the maximal limit.

But I recently noted that the high voltage raised the pain reduction rate.

So, I will increase the voltage until the patient feels comfortable.

I increased to 65 voltage.
It is now 75 voltage.

She is so comfortable. So, I will come closer to the nerve root while constantly asking questions.

The signal from the L4 nerve root travel to the anterior thigh, and L5 elicits posterior thigh and peroneal territory.

Would you please turn to the contralateral oblique view?
Now, she felt a sensory change but was still comfortable.

She will stay for 20 minutes long.
I came back and will remove the electrodes.
After confirming the contrast media spread, I will administer a steroid mixture.


Thank you for watching. See you in the following videos.


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