电刺激治疗术后截瘫

Application of Radiofrequency in Failed Back Surgery Syndrome (with video presentation),Wei Gong Memorial HospitalChao-Jan Wang /王超然 M.D.M.S.,Wei Gong Memorial Hospital財團法人為恭紀念醫院,Stereotactic Cingulotomy for Cancer Pain,Instability of lumbar spine surgery :,What is “Spine Man”?,Tx : Spinal surgical disease or Spinal disease,Treatment of spinal disease :The indication ?,Spinal structure neural tissue surgery Pain control,Strategy of FBSS(I) :,Detail Spinal Surgical History,Strategies of FBSS(2):,Lesion Radiofrequency Lumbar Facet Denervation IDL or IDETPulsed RadiofrequencyLumbar DRG stimulation,Therapeutic Diagnosis of Failed Back Surgery Syndrome With Lumbar Facet Denervation ( Video Presentation ),Lumbar Facet Syndrome Pain Referral Map:,Lumbar X ray & CT finding in FBSS,Radiographic evidence : equivocal utility.May be narrowing of the interbody disc space and the painful level.If the patient has had a lumbar fusion, common to develop facet joint pain above the fusion level.The patient has had disectomy, causing increasing pressure on the facet joint at that level.,Diagnose,Through a diagnostic block But : False positives,Results of Facet Denervation in FBSS : 2003/01/01 - 2003/12/31.,Conclusion,Lumbar percutaneous facet denervation offers a minimally invasive therapeutic diagnosis for sufferers of failed back surgery syndrome.The efficacy of facet denervation for previous lumbar surgery?,DRG pulsed radiofrequency,Inspired :,1999,Rajesh Munglani,” The longer effect of pulsed radiofrequency for neuropathic pain”, Pain 80,p437-439.4 cases suffered FBSS treated with Pulsed Radiofrequency :Followed up :7 months , 6 months, 1 month , 2 months.All of them revealed excellent outcome.,1997 , Robert Slappendel et al. “ The efficacy of radiofrequency lesion of the cervical spinal dorsal root ganglion in a double blinded randomized study: no difference between 40 C and 67 C treatment. “ Pain 73 p159-163,Amplitude,Amplitude,OFF,ON,Difference in Amplitude for Continuous RF and Pulsed RF,ON,Application field :,Facet syndrome Failed back syndrome.Stellate ganglion blockNeuropathic painDM with neuropathy (?)Herpes Zoster with neuropathy.Mild to Moderate CTSParathropathy of the knee, hipInsertion myotendinosen at the iliac crestPrimary and secondary intercostal neuralgia,Peripheral neuralgia sensory nerveOcciptal neuralgiaTrigeminal neuralgiaNeuroma conditioned pain syndromeMultiple SclerosisCoccygodyniaPostdiscetomie syndromeSympathetic conditioned pain,RF lesion adjacent to the dorsal root lesion only transient sensory loss in the relevant dermatome ,pain relief may be of much longer duration.A selective action of heat on unmyelinated C-fibers ,but could not be corroborated by pathological studies.(1981,Smith HP,J Neurosurg),Mechanism :,Mechanism :,Delivering an EMF without producing neurodestructive heat:Maximal tip temperative of 42C.Can be applied in a pulsed fashion. .(1981,Smith HP,J Neurosurg),The electric field :,Large E-field rise to large differential electric field stress on membranes and molecules within the nerve cells.cause permanent configurational changes: including destruction of membranes and molecular chains,then they could have major effects on cell function.Such effects may vary in degree from myelinated to unmyelinated structures because of the capacitive character of the myelin sheath. (1998, Menno . Sluijer et al ,The Pain Clinic),PULSED RF: ADVANTAGES,The PRF procedures are not neuro destructive nor do they produce temporary sensory deficitIt can be used in neuropathic painLess discomfort after the procedureCan be used where conventional RF is “forbidden”,CASE I,General data,Sex : male Age : 52 yearsChief complain : Severe low back pain with soreness with bilateral lower limbs weakness for years and accepted surgical intervention in 2003 , February. But the symptom persistently existed after surgery.,Results of Pulsed Radiofrequency:2003/01/01 - 2003/12/31.,Conclusion（1）:,The pulsed radiofrequency can apply to functional nerve , highly selective block C fiber long term duration and pres