Image-Guided Spine Interventions by John M. Mathis & Stanley Golovac

Author:John M. Mathis & Stanley Golovac
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Indications

The procedure is indicated for patients with shoulder pain who have been evaluated by a shoulder specialist and found not to be a candidate for surgery. Many of these patients have had a prior rotator cuff repair and still have pain. It is also indicated for patients with a frozen shoulder from any cause. Patients must have responded positively (70-100% reduction in pain) to blockade of the nerve with local anesthetic on two separate occasions are candidates for PRF.

Technique

Fluoroscopy is used to perform the procedure. The patient is placed in a prone position on the table. It can sometimes be difficult to visualize the suprascapular notch. The technique is to angle the c-arm in a cephalo-caudal direction and then oblique towards the affected side. The suprascapular notch is identified just above the spine of the scapula and medial to the coricoid process.47 After sterile prep and drape, a 5 cm RFK needle with a 4 mm active tip is advanced down the angle of the X-ray beam in order to position the needle perpendicular to the nerve (Figure 9.9a, b). Next, the nerve is stimulated at 50 Hz with the intention of obtaining a paresthesia in the shoulder at less than 0.2 V. This should be repeated to test for reproducibility. It is not necessary to perform motor stimulation, as PRF does not affect motor fibers. Then the impedance is checked. It should register at less than 400 ohms. If not, saline is injected. It is important not to numb the targeted nerve in order to ensure that the patient feels continued pulsing throughout the entire procedure. Finally, the nerve is lesioned in the pulsed mode for 4 min at 2 Hz, and 45-60 V. It is not necessary to measure temperature as long as it stays below 42°C. The operator should hold the needle in place throughout the procedure and occasionally ask the patient if they continue to feel pulsing. If not, it implies that the tip has moved away from the targeted nerve and is no longer producing any effect. A visible pulsation of the supraspinatus and infraspinatus muscles will be seen.47

Figure 9.9.(A) This is an image of a 5-cm needle directed at the suprascapular nerve located within the notch. (B) This provides a good view of the suprascapular notch with a RF needle located medial to the target point.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.