Earlier this week, I went with a client to a neurologist for an RF ablation (of different nerves... not a facet rhizotomy.) He has a very unusual presentation and a difficult case, but that is not what this discussion is about and it will be up to him to share his case if he wishes... so please don't ask me questions about him.
I was fortunate enough to be present in the OR for this treatment and learned a great deal about this procedure and much more (which I'll post later in another thread.)
I had always thought of RF ablation as burning through the nerve and have images of RF, laser and bipolar application of energy that I've seen in many, many surgeries. It sometimes looks like barbecue time with charring of tissue, vaporization of tissue and some real serious cooking going on.
Instead, what I saw was, after local anesthetic, very careful placement of the RF probe on one side of the channel that the nerves run through. After proper placement was verified (with flouroscopic imaging on the coolest, most modern c-arm I've ever seen), energy was applied to the probe for 90 seconds. The area was only heated to 80 degrees C. They are not burning the nerve. They are not destroying or immediately ablating tissue. After a burn, the probe is repositioned a mm or so to march across the channel to make sure that the entire nerve pathway is treated. There were a total of 5 or 6 applications of energy and in moving from one side of the channel to the other, additional application of local anesthesia was needed.
The application of energy does not immediately ablate the nerve. It damages them so they'll eventually die. To me, this sounds like spraying Roundup on weeds. They look the same when you are done spraying, but they are damaged and will die. It explains why people have pain caused by the procedure for some period of time... usually a few days, often as much as 10 or more. It's supposed to feel like a sunburn as that's essentially what's happened. As with all things spine, responses are all over the place... some people have little pain that fades quickly, while others have more pain that fades slowly.
I had asked about the potential for partial ablation being problematic. The doctor explained that it is possible, but it's not usually a long-term problem. By definition of the procedure, you've partially ablated the nerve and you are waiting for the ablation to become total as the nerve damages progresses in the days following the procedure. If the ablation never becomes total, it may be painful longer as the 'sunburn' will take longer to fade, but eventually you'll be as you will be in the future anyways... as the nerves will grow back in 6 to 18 months (my numbers... not the neurologist... I could be wrong here.) This phase of the nerves growing back is just like the partial ablation as the nerves are dying or of the ablation was not complete. The procedure can be repeated if needed.
I do not know how this procedure compares to a facet rhizotomy... look forward to learning more as I spend additional time in the OR with more varied procedures.
I believe that this neurologist is excellent and may have much to offer many of the people I know who are having difficulty getting a proper diagnosis. I'll post much more later as I learned a ton about different treatments and diagnostic techniques. I look forward to working with him:
Dr. Sheldon Jordan, Santa Monica, CA
More to come...
Mark
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