电刺激治疗术后截瘫课件

ApplicationofRadiofrequencyin

FailedBackSurgerySyndrome

(withvideopresentation)

WeiGongMemorialHospitalChao-JanWang/王超然M.D.M.S.WeiGongMemorialHospital財團法人為恭紀念醫院StereotacticCingulotomyforCancerPainInstabilityoflumbarspinesurgery:Whatis“SpineMan〞?Tx:Spinalsurgicaldiseaseor

SpinaldiseaseTreatmentofspinaldisease:Theindication?

Spinalstructureneuraltissue

surgeryPaincontrolStrategyofFBSS(I):FBSS(FailedBackSurgerySyndrome)WithoutradiculopathysurgeryWithradiculopathyL2PulsedradiofrequencyEpiduralInjectionProcedureNeuralcompressionRe-opensurgeryImagingStudiesPulsedradiofrequencySympatheticBlockImagingStudiesIDET(Discogram)FacetDenervationNCV/EMGMappingPulsedradiofrequencyIDETSpinalCordStimulationPostMulti-operationDetailSpinalSurgicalHistoryStrategiesofFBSS(2):LesionRadiofrequency

LumbarFacetDenervationIDLorIDETPulsedRadiofrequencyLumbarDRGstimulationTherapeuticDiagnosisof

FailedBackSurgerySyndrome

With

LumbarFacetDenervation

(VideoPresentation)

LumbarFacetSyndromePainReferralMap:LumbarXray&CTfindinginFBSSRadiographicevidence:equivocalutility.Maybenarrowingoftheinterbodydiscspaceandthepainfullevel.Ifthepatienthashadalumbarfusion,commontodevelopfacetjointpainabove

thefusionlevel.Thepatienthashaddisectomy,causingincreasingpressureonthefacetjointatthatlevel.

Diagnose

Throughadiagnosticblock

But:Falsepositives

CasenumberInitialoutcome(improvedrate)3monthsF/U6monthsF/UFailedbacksyndrome2612(46%)6(23%)2(8%)

ResultsofFacetDenervationinFBSS:

2003/01/01-2003/12/31.

ConclusionLumbarpercutaneousfacetdenervationoffersaminimallyinvasivetherapeuticdiagnosisforsufferersoffailedbacksurgerysyndrome.Theefficacyoffacetdenervationforpreviouslumbarsurgery?DRGpulsedradiofrequencyInspired:1999,RajeshMunglani,〞Thelongereffectofpulsedradiofrequencyforneuropathicpain〞,Pain80,p437-439.4casessufferedFBSStreatedwithPulsedRadiofrequency:Followedup:7months,6months,1month,2months.Allofthemrevealedexcellentoutcome.1997,RobertSlappendeletal.“Theefficacyofradiofrequencylesionofthecervicalspinaldorsalrootganglioninadoubleblindedrandomizedstudy:nodifference

between40°Cand67°Ctreatment.“Pain73p159-163AmplitudeAmplitudeOFFONDifferenceinAmplitudeforContinuousRFandPulsedRFONApplicationfield:FacetsyndromeFailedbacksyndrome.StellateganglionblockNeuropathicpainDMwithneuropathy(?)HerpesZosterwithneuropathy.MildtoModerateCTSParathropathyoftheknee,hipInsertionmyotendinosenattheiliaccrestPrimaryandsecondaryintercostalneuralgiaPeripheralneuralgiasensorynerveOcciptalneuralgiaTrigeminalneuralgiaNeuromaconditionedpainsyndromeMultipleSclerosisCoccygodyniaPostdiscetomiesyndromeSympatheticconditionedpainRFlesionadjacenttothedorsalrootlesion–onlytransientsensorylossintherelevantdermatome,painreliefmaybeofmuchlongerduration.AselectiveactionofheatonunmyelinatedC-fibers,butcouldnotbecorroboratedbypathologicalstudies.(1981,SmithHP,JNeurosurg)Mechanism:Mechanism:

DeliveringanEMFwithoutproducingneurodestructiveheat:Maximaltiptemperativeof42ºC.Canbeappliedinapulsedfashion..(1981,SmithHP,JNeurosurg)Theelectricfield:LargeE-field–risetolargedifferentialelectricfieldstressonmembranesandmoleculeswithinthenervecells.cause

permanentconfigurationalchanges:includingdestructionofmembranesandmolecularchains,thentheycouldhavemajoreffectsoncellfunction.Sucheffectsmayvaryindegreefrommyelinatedtounmyelinatedstructuresbecauseofthecapacitivecharacterofthemyelinsheath.(1998,Menno.Sluijeretal,ThePainClinic)PULSEDRF:

ADVANTAGESThePRFproceduresarenotneurodestructivenordotheyproducetemporarysensorydeficitItcanbeusedinneuropathicpainLessdiscomfortaftertheprocedureCanbeusedwhereconventionalRFis“forbidden〞CASEIGeneraldataSex:maleAge:52yearsChiefcomplain:Severelowbackpainwithsorenesswithbilaterallowerlimbsweaknessforyearsandacceptedsurgicalinterventionin2003,February.Butthesymptompersistentlyexistedaftersurgery.CasenumberInitialoutcome(improvedrate)3monthsF/U6monthsF/UChroniclowbackpain(lumbarfacetsyndrome&discogenicpain)4036(90%)23(56%)20(40%)Failedbacksyndrome2218(82%)10(45%)6(27%)ResultsofPulsedRadiofrequency:

2003/01/01-2003/12/31.

Conclusion〔1〕:Thepulsedradiofrequencycanapplytofunctionalnerve,highlyselectiveblock

Cfiberlongtermdurationandpreservemotorfiber.An

effective,safetyandminimalinvasivetherapytopatientswhosufferedintractablespinalandneuropathicpainincludingFBSS.Conclusion〔2〕Chroniclumbarspinalpain(withsurgery)PostsurgerywithneuralinjuryPostsurgeryFailbacksyndromePulsedradiofrequencyMRINeuralcompressionNoneuralcompressionsurgeryPoorresponsePulsedradiofrequencyPulsedradiofrequencysurgeryWithradiculopathyWithoutradiculopathyNCV/EMGPulsedradiofrequency