E.G. Melidi, A.L. Krivoshapkin, A.R. Duyshobaev, A.S. Petrovskaya
Neurosurgical Centre of Railway Clinical Hospital, Novosibirsk, Russia
Specialists of the Novosibirsk Neurosurgical Center started to use little-invasive radiofrequency thermodestruction (RT) in August 2001. Its purpose was breaking off a pathologic chain of pain syndrome. The REG-3 radiofrequency generator (Radionics) was used. Precise assessment of neurophysiologic peculiarities of chronic pain was carried out with the Viking IV M device (Nicolet). Short-latent brain stem evoked potentials (SBSEP) were recorded pre-, intra- and postoperatively.
There were 401 cases with different chronic pain syndromes (188 males and 213 females). Their mean age was 56.5±7.8 years. Distribution of cases, depending on pathology, was as follows: different syndromes in the vertebral column area – 212 (52.8%); ischemic lesions and/or chronic osteomyelitis of extremities – 44 (11.1%); complex prosopalgias – 145 (36.1%).
Results. Different RT methods were used for performing 457 operations. Among them one can mention facet denervation or its combination with partial spinal rhizotomy, RT of the stellate ganglion and sympathetic trunk at a lumbar level (L2-L4), selective destruction of a sensitive portion of the trigeminal nerve branches and pterygopalatine ganglion. A good or excellent analgesic effect was watched in 89.2% of cases (358) during the second postoperative week (a score of 3 according to the Visual-Analog Scale). Some cases (14.2%) demanded repeated manipulation in 16.2 months for pain syndrome arrest. There were no fatal outcomes, serious complication or negative results.
Conclusion. Radiofrequency thermodestruction is an effective little-invasive method of chronic pain syndrome treatment. Neurophysiologic monitoring of SBSEP allows to prognosticate conditions of pain recurrence and to prevent areflexia appearance after operation.