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A Retrospective Chart Review Analyzing the Safety of Spinal Radiofrequency Procedures in Patients who have Metallic Posterior Spinal Instrumentation
Session: MP-02a
Thurs, Nov. 16, 10 am-12 pm
Hampton Room

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.

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A Retrospective Chart Review Analyzing the Safety of Spinal Radiofrequency Procedures in Patients who have Metallic Posterior Spinal Instrumentation   

By: Stephen Ellwood, BS1, Peter Shupper, MD1, Andrew Kaufman, MD1

1Rutgers New Jersey Medical School, Department of Anesthesiology, Newark, N.J.

 

Introduction:

•Radiofrequency neurotomy (RFN) procedures are safe and efficacious for the treatment of pain associated with facet joint arthropathy (FJA).1,2 
•Patients who have undergone spinal fusion procedures are at risk for adjacent segment facet joint pain.3  
•Recent studies have shown that RFN at the level of a pedicle screw can increase pedicle screw temperature, and speculate that pedicle screw heating may cause thermal injury.4,5
•Klessinger et. al. evaluated the safety and efficacy of RFN in the presence of posterior pedicle screws in the lumbar spine; no effect from heated metal devices was detected and no adverse effects or worsening pain, were observed. 6

We present a retrospective chart review of patients with posterior spinal instrumentation in the cervical, thoracic, and lumbar spine who underwent RFN at the level of pedicle screws.  The purpose of this review was to determine if there were any serious complications after RFN that could be attributable to heated instrumentation. 

Methods:

•Radiofrequency neurotomy (RFN) procedures are safe and efficacious for the treatment of pain associated with facet joint arthropathy (FJA).1,2 
•Patients who have undergone spinal fusion procedures are at risk for adjacent segment facet joint pain.3  
•Recent studies have shown that RFN at the level of a pedicle screw can increase pedicle screw temperature, and speculate that pedicle screw heating may cause thermal injury.4,5
•Klessinger et. al. evaluated the safety and efficacy of RFN in the presence of posterior pedicle screws in the lumbar spine; no effect from heated metal devices was detected and no adverse effects or worsening pain, were observed. 6

We present a retrospective chart review of patients with posterior spinal instrumentation in the cervical, thoracic, and lumbar spine who underwent RFN at the level of pedicle screws.  The purpose of this review was to determine if there were any serious complications after RFN that could be attributable to heated instrumentation. 

Results:

Patient Characteristics- 

507 charts reviewed, 36 met inclusion criteria

Men:  17 (43.6%)   Women: 22 (56.4%)

Median Age:  58       Age Range: 25-87

Total RFNs: 56

RFN Locations: 11 cervical, 44 lumbar, 1 thoracic 

*All post-RFN complications were determined to be unrelated to potential increased temperature of pedicle screws or thermal injury

Discussion:

This is the first study to include patients with cervical and thoracic pedicle screws in analysis of safety of RFN procedures at the level of posterior pedicle screws. Although there is evidence that RFN can increase pedicle screw temperature4,5, no effect from heated metal devices was detected in this retrospective review.  To our knowledge, there have been no documented cases of RFN-related adverse events directly attributable to the heating of metallic spinal hardware.6

While heating of pedicle screws may occur with RFN, this seems to be largely dependent on the proximity of the RF probe to the screw.  In a cadaver study, RF cannulas placed at or near the conventional RFN targets (but not in direct contact with the pedicle screw), caused screw temperature increases of 0.86-1.84°C above pre-RF baseline temperature.5 it is unlikely that this temperature increase causes clinically significant effects, as demonstrated in our review.

Conclusions:

•There have been no reported complications of medial branch RFN at the level of a pedicle screw attributed to hardware temperature increases.
•Ensuring the RFN cannula is not in contact with the pedicle screw is very important. 

 References:

1.Manchikanti L, Kaye AD, Boswell MV, et al. A Systematic Review and Best Evidence Synthesis of the Effectiveness of Therapeutic Facet Joint Interventions in Managing Chronic Spinal Pain. Pain physician. 2015;18(4):E535-582.
2.MacVicar J, Borowczyk JM, MacVicar AM, Loughnan BM, Bogduk N. Cervical medial branch radiofrequency neurotomy in New Zealand. Pain medicine (Malden, Mass). 2012;13(5):647-654.
3.Lawrence BD, Wang J, Arnold PM, Hermsmeyer J, Norvell DC, Brodke DS. Predicting the risk of adjacent segment pathology after lumbar fusion: a systematic review. Spine. 2012;37(22 Suppl):S123-132.
4.Lamer TJ, Smith J, Hoelzer BC, Mauck WD, Qu W, Gazelka HM. Safety of Lumbar Spine Radiofrequency Procedures in Patients Who Have Posterior Spinal Hardware. Pain medicine (Malden, Mass). 2016;17(9):1634-1637.
5.Gazelka HM, Welch TL, Nassr A, Lamer TJ. Safety of lumbar spine radiofrequency procedures in the presence of posterior pedicle screws: technical report of a cadaver study. Pain medicine (Malden, Mass). 2015;16(5):877-880.
6.Klessinger S. Safety and Efficacy of Lumbar Spine Radiofrequency Neurotomy in the Presence of Posterior Pedicle Screws. Prog Orthop Sci. 2016; 2(3). 


 

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