RT Book, Section
A1 Paterno, Josemaria
A1 Rathmell, James P.
A1 Gilligan, Chris
A2 Bajwa, Zahid H.
A2 Wootton, R. Joshua
A2 Warfield, Carol A.
SR Print(0)
ID 1131938823
T1 Cryoanalgesia and Radiofrequency Ablation
T2 Principles and Practice of Pain Medicine, 3e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9780071766838
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1131938823
RD 2024/04/19
AB Radiofrequency  ablation  (RFA)  has  an  established  and  expanding  role  in  the  treatment  of  a  myriad  of  pain  conditions.  As  early  as  the  1930s,  the  application  of  electric  current  for  neural  ablation  was  reported  in  the  medical  literature.  Clinicians  initially  used  large  (12–14  gauge)  electrodes  emitting  direct  current,  which  risked  mechanical  injury  and  produced  unpredictable  lesions.1  However,  investigators  soon  discovered  that  alternating  current  in  the  radiofrequency  (RF)  range  between  300  and  500  KHz  created  more  predictable  lesions.2,3  In  the  early  1950s,  the  first  commercial  RF  lesion  generator  became  available  through  the  collaboration  between  electrical  engineer  Bernard  Cosman  and  neurosurgeon  Thomas  Sweet  at  the  Massachusetts  General  Hospital.  In  1975,  RFA  was  first  described  in  the  literature  for  the  treatment  of  back  pain.1,4  Over  the  subsequent  decades,  RFA  has  become  a  widespread  and  effective  treatment  to  create  significant  and  sustained  pain  relief.  Current  and  expanding  clinical  applications  of  RFA  include  facial;  cervical,  thoracic,  and  lumbar  facet;  spinal  radicular;  sacroiliac  joint  (SIJ);  lumbar  discogenic;  peripheral  nerve;  intraarticular  joint;  and  sympathetically  mediated  pain.  The  bulk  of  clinical  data  involves  conventional  RFA;  however,  over  the  past  decade,  modified  forms  of  RF  treatments  have  emerged.  Today  four  forms  of  RFA  predominate  in  clinical  use:  conventional  (i.e.  continuous)  RFA  (CRF),  pulsed  RFA  (PRF),  water-cooled  RFA  (WCRF),  and  bipolar  RFA  (BRF)  (Fig.  91-1):