Radio Frequency Ablation (Denver Pain Management ,2009)

Radiofrequency (RF) and pulsed radiofrequency (PRF) neurolysis are techniques used to treat chronic pain that is transmitted through the sensory nerves. RF neurolysis utilizes heat to destroy selected nerve fibers, which block pain transmission through the neural pathway. These techniques are used when intermittent anesthetic injections no longer provide extended pain relief.

Chronic cervical, lumbar and sacral pain  can come from your facet joints.  These pain signals can be interrupted by blocking the nerve to the facet joint with an anesthetic injection  this is very temporary (facet block), For longer lasting relief the nerve can be  heated using a radiofrequency wave (radiofrequency ablation) . This can often prevent the neural transmission of pain. The nerve to the facet joint is sometimes referred to as the “medial branch” and therefore a facet nerve block is also referred to as “medial branch” block.  These blocks are performed as a part of a diagnostic workup for back or neck pain. Relief following a precise injection of local anesthetic confirms the facet joint as the source of pain.

 Radiofrequency neurolysis is a procedure in which sensory afferent nerve fibers are selectively destroyed with heat produced by radio waves delivered through an electrode.  Treatment objectives are to eliminate pain, reduce the likelihood of recurrence and prolong the time to recurrence by selectively destroying pain fibers without inducing excessive sensory loss, motor dysfunction, or other complications. Radiofrequency (RF) neurolysis carries  the potential risk of neuritis (nerve inflammation). Histological studies have revealed indiscriminate destruction of both small and large fibers following RF treatment.

 Pulsed radiofrequency  is thought to be a less destructive alternative to standard RF in that it applies RF energy with a pulsed time cycle that delivers short bursts of RF current instead of a continuous RF flow. By pulsing the electrical current, the needle remains relatively cool (up to 42 degrees celsius compared to temperatures of 60-69 degrees celsius with continuous RF) so that the tissue cools slightly between each burst, reducing the risk of destroying nearby tissue and preventing any long-term damage to the nerve. The reasoning behind this is transmission of impulses across small unmyelinated fibers is disrupted while larger fibers remain protected by the myelin sheath.

 Some researchers show short term success with pulsed radio frequency in comparison to radio frequency lesioning. However others are reporting success rate of over nineteen months. It would seem that results could be altered by the skill of the spine care practitioner it is crucial to choose carefully.

DMX for diganostics

DIGITAL MOTION X-RAY® is a diagnostic test that records real time, full motion x-ray imaging of any body joint in motion. DMX® can often unlock the mystery of spinal pain. It is common knowledge among spinal care professionals including surgeons that damage to ligaments, tendons and underlying support structures can not be corrected with surgery or physiotherapy alone. Until now it has been difficult to diagnose these injuries objectively. Serious ligamentous and facet joint injuries are well documented at autopsy however this is not a working solution for live patients in need of care! Should you ask your doctor to order a DMX® exam for you?…. To find out ask yourself these questions:

• Do I have pain in one or more of my joints that increases with motion?

• Did I injure myself with a sudden jolt to one or more of my joints, as a whiplash injury, slip and fall or blow from a sporting activity?

• Do I have joint pain, the cause of which has not been determined by conventional x-ray, MRI or other diagnostic tests?

If you have answered yes to any of the above, consider a DMX® examination.

Stretched and torn ligaments can result in a condition called “kinesiopathology” or abnormal motion of the bones that make up the joint. This abnormal motion results in ongoing rubbing and grinding of the bone surfaces during motion, preventing normal healing, and leading to premature onset of degenerative joint disease, a wear and tear type of arthritis.  DMX® can fully evaluate internal joint motion, and properly screen for kinesiopathology

What Makes DMX® unique?

Good question! Auto accident injuries occur in milliseconds, too quick for the human nervous system to react and protect. This leaves only bones and ligaments to protect the body. Since cervical bones are rarely broken, the connective tissues are most commonly injured.

The Hidden Culprit – Ligaments

Ligaments are connective tissue that attach bone to bone. The purpose of ligaments is to keep bones in proper position, and work similar to hinges on a door. It has been suspected that ligaments are damaged easily, but until now, it has been difficult to diagnose ligamentous injuries. DMX® can demonstrate these injuries in as little as 15 minutes.

DMX® visually demonstrates aberrant movement of bones, allowing the radiologist to specifically determine which ligaments are injured. Treatment can then be tailored to the patient’s need and progress can be assessed with the help of DMX®. Promising solutions for tissue regeneration are currently in development at the Spinal Injury Foundation.

With the help of DMX® these injuries can be seen from the inside out

A perfect egg sample

Common sense will tell you that one cannot determine the injury an accident victim has suffered by merely looking at the outer shell of the car. When we buy eggs, how often do we open the carton to check if the eggs on the inside are broken? Every time!

Experience teaches that we cannot determine the condition of the egg by looking at the container. The same holds true for a person’s body – the evidence is in the person’s body, not the car.

Although high TESLA MRIs can pick up ligament damage they are sometimes less available that DMX. For information on MRIs see this link