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Percutaneous radiofrequency denervation of spinal facets

Treatment for chronic back pain and sciatica

C. Norman Shealy

: Multiple bilateral subcutaneous rhizolysis of segmentai nerves in the treatment of the intervertebral disc syndrome. Ann Gen Prac 26 : 126 – 127 , 1971 Rees WES: Multiple bilateral subcutaneous rhizolysis of segmentai nerves in the treatment of the intervertebral disc syndrome. Ann Gen Prac 26: 126–127, 1971 9. Shealy CN , Preito A , Burton C , et al : Radiofrequency percutaneous rhizotomy of the articular nerve of Luschka: an alternative approach to chronic low back pain and sciatica. Presented at

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Stephen J. Haines

most misleading. Rees 37 described the procedure of multiple bilateral percutaneous rhizolysis for the treatment of low-back pain. His clinical trial consisted of 5000 consecutive patients in whom he implied a high rate of success in pain relief. He implied that this success rate was superior to that of more standard procedures. Controlled studies by King, 26 however, not only demonstrated facet denervation to have no greater effect than placebo, but demolished the anatomic basis for the procedure as performed by Rees. Many patients could have been spared this

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Nikolai Bogduk and Don M. Long

F acet denervation, facet rhizotomy, and facet rhizolysis is a procedure currently being used in some centers for the treatment of low-back pain syndromes. “Encouraging” success has been claimed for it. 12 The rationale for the operation is that the “facet” joints in the back are the source of pain; the operation is designed to denervate these joints. The literature describing the operation, however, contains several anatomical inaccuracies in descriptions of the techniques. The facet joints are unlikely to be specifically denervated by the procedure

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Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia : WB Saunders , 1976 , pp 89 – 94 King JS: Randomized trial of the Rees and Shealy methods for the treatment for low back pain, in Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia: WB Saunders, 1976, pp 89–94 9. Rees WS : Disconnective neurosurgery: multiple bilateral percutaneous rhizolysis (facet rhizotomy) , in Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia : WB Saunders , 1976 , pp 80

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and adults Shozo Yasuoka Hamlet A. Peterson Collin S. MacCarty October 1982 57 4 441 445 10.3171/jns.1982.57.4.0441 Medulloblastoma and other primary malignant neuroectodermal tumors of the CNS Jeffrey C. Allen Fred Epstein October 1982 57 4 446 451 10.3171/jns.1982.57.4.0446 The neurosurgical management of optic glioma Robert T. Tenny Edward R. Laws Jr. Brian R. Younge James A. Rush October 1982 57 4 452 458 10.3171/jns.1982.57.4.0452 Surgical control of chronic migrainous neuralgia by trigeminal ganglio-rhizolysis Robert E. Maxwell October

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Robert E. Maxwell

anesthetic. In such cases, prolonged relief can be achieved with percutaneous trigeminal ganglio-rhizolysis. This series of eight patients was compared retrospectively with 15 other patients who underwent trigeminal ganglionic blockade with 1% lidocaine as part of their evaluation for chronic craniofacial pain. The 15 patients formed a more heterogeneous group, not fitting into a single definable syndrome. Six female patients were classified as having facial migraine, and the other nine patients were considered as suffering atypical cranial neuralgias or atypical facial

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Brett A. Scott, Zelig Weinstein, Robert Chiteman and Morris W. Pulliam

clearly outlined. Lumbar puncture was performed at L1–2. Discussion Lower extremity spasticity after spinal cord injury can be incapacitating, may retard rehabilitation, and may be associated with intractable decubitus ulcers. 3, 8 Chemical rhizolysis using phenol or ethanol destroys neurons, and thereby interrupts reflex arcs mediated by the treated nerve roots. Ethanol is hypobaric relative to cerebrospinal fluid (CSF); it is radiolucent and causes rapid, permanent destruction of nerve fibers, 16 hence, accurate restriction of treatment to a selected

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Ronald F. Young

Trigeminal Nerve No. of Cases 1 2 2 23 3 29 1, 2 18 2, 3 76 1, 2, 3 14 All patients underwent computerized tomography or magnetic resonance scanning to evaluate possible structural intracranial causes for their facial pain, with negative results. All patients were offered the surgical alternatives of microvascular decompression, radiofrequency rhizotomy, or glycerol injection. Technique of Glycerol Rhizolysis All patients were admitted to the Outpatient Surgical Unit on the morning of the procedure

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rhizolysis for treatment of trigeminal neuralgia Ronald F. Young July 1988 69 1 39 45 10.3171/jns.1988.69.1.0039 Superficial temporal-middle cerebral artery bypass: clinical pre- and postoperative angiographic correlation Clifford R. Jack Jr. Thoralf M. Sundt Jr. Nicolee C. Fode Dale G. Gehring July 1988 69 1 46 51 10.3171/jns.1988.69.1.0046 Prophylactic parenteral antibiotics in clean neurosurgical procedures: a review Robert Dempsey Robert P. Rapp Byron Young Sarah Johnston Phillip Tibbs July

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rhizolysis in the management of trigeminal neuralgia Kim J. Burchiel September 1988 69 3 361 366 10.3171/jns.1988.69.3.0361 Hearing loss after microvascular decompression for trigeminal neuralgia Wolfram Fritz Jürgen Schäfer Heinz J. Klein September 1988 69 3 367 370 10.3171/jns.1988.69.3.0367 Cell kinetics studies of human brain tumors by in vitro labeling using anti-BUdR monoclonal antibody Takafumi Nishizaki Tetsuji Orita Masahide Saiki Yasuhiro Furutani Hideo Aoki September 1988 69 3 371 374 10