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Pros and Cons of Larger Lesions

Anonymous on February 5, 2021 at 10:05 pm
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    • Anonymous
      #66275

      For years I have been using the more expensive, larger lesion RF cannulas, on the assumption this would provide better outcomes. I have recently learned that a lesion too large can be dangerous, because it can damage the surrounding supportive structures. What is your opinion on the pros and cons for these larger lesion cannulas? I am hearing conflicting data.

      • Fabricio Dias AssisFabricio Dias Assis
        Participant
        Joined: Sep 6, 2016
        Posts: 5
        #68160

        The choice of the most appropriate cannula depends on the procedure you will perform. The size of a RF lesion depends on the size of the cannula, the exposure time and the temperature applied. Larger lesions can be produced modifying any of these parameters. The use of cooled RF, bipolar RF, expandable cannulas or simply a large cannula with a longer exposure time are the most common ways to get larger lesions. It is mandatory in these cases to make motor stimulation at 2Hz up to 3V to avoid any nerve damage, specially for the middle branch making sure you are far from the nerve root. There are few studies comparing Cooled X Conventional RF for lumbar facet joint mediated pain with conflicting data regarding the outcomes. According to a consensus from a multispecialty, international working group the use of larger lesions may increase the likelihood of capturing the targeted structures and care should be taken to avoid limit damage of the surrounding structures (https://rapm.bmj.com/content/rapm/early/2020/04/03/rapm-2019-101243.full.pdf). I personally use larger lesions like cooled RF in my patients and always make 2Hz motor stimulation up to 3V to make sure I am good and no radicular response is seen.

        • Anonymous
          #68417

          Dr. Dias Assis,

          Thank you for that very thorough explanation. I’d like to maximize lesion size using a monopolar RF with a 16g probe at 90 C. Do you think this extra 10 C will damage any structures or alter the surrounding fluids? And do you think 90 C will in anyway capture more of the targeted nerve?

          Thank you!

          • Fabricio Dias AssisFabricio Dias Assis
            Participant
            Joined: Sep 6, 2016
            Posts: 5
            #68527

            Hello!
            Attached a paper that compares 80 and 90 degrees Celsius for medial branch RF denervation with better results and no more complications for the 90 group.
            Since this paper I apply 90 degrees Celsius for 90s with a 16 or 18 G 10mm active tip needle in my patients. Never had a complication more than a transient worsening of pain.
            So I think you are right, just pay attention in the motor stimulation. I would go up to 3V to make sure I don’t have any radicular stimulation.
            All the best

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