Radiofrequency Neurotomy of the Cervical Facet Joints
Alexander R. Vaccaro, Christopher M. Bono in Minimally Invasive Spine Surgery, 2007
Compared with electrocautery and neurolytic agents such as phenol, radiofrequency generates lesions that are smooth, regular, well-circumscribed, and confined to restricted areas. By monitoring the rate of heating, temperature can be maintained under 85°C thereby preventing gas formation, boiling, vaporization, explosive reactions, and cavitation (23,24). The lesion size can be reproducibly quantified. Successful execution of the procedure ensures long lasting effects with no major sensory or motor complications, unlike surgical neurectomy. No permanent damage has been reported and, when indicated, the procedure can be repeated. The electrodes are robust and easily made to different configurations to suit specific anatomical usage (12,25). The procedure can performed under local anesthetic and postoperative recovery time is minimized.
General Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
You repair the inguinal hernia but he presents 3 months later with chronic groin pain (inguinodynia). How will you manage him?Inguinodynia affects up to 40% of patients.It can be due to neuropathic (local injury) or non-neuropathic (mesh-related) fibrosis of ilioinguinal, iliohypogastric and genital branch of genitofemoral nerves.Risk factors include young age, preoperative pain and pain at other sites.Management: Lifestyle modification, NSAIDs, tricyclics and surgical or chemical neurectomy in selected cases offer a successful recovery, although there is no consensus in the treatment approach.A prophylactic neurectomy during hernia repair significantly decreases the incidence of inguinodynia.Referral to the chronic pain team should be considered if this does not settle with these measures.
Chronic pelvic pain
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
In some cases, with multiple trigger points in the vaginal wall, back, and abdominal wall, a series of abdominal nerve, caudal, pudendal or epidural blocks may prove to be more fruitful in treating the pain than multiple trigger point injections.10[III] Nerve blocks with local anesthetics may provide relief of neuralgia due to nerve injury. Prolonged partial pain relief may occur for weeks or months following one or more nerve blocks beyond the anticipated duration of the local anesthetic. The explanation for prolonged pain relief may be secondary to reduced capacity of the nerve to maintain repetitive impulses, decreased excitability of the nerve fiber, and systemic uptake of the anesthetic. Nerve blocks have also been used as a prerequisite for evaluating potential effectiveness prior to neurectomy.148[III] Superior hypogastric plexus block by CT guidance and at the time of microlaparoscopy may provide further evaluation and management in chronic pelvic pain.149, 150[III] CT guidance has also been found to be useful for needle guidance in pudendal nerve blocks.151[III]
Chronic peripheral nerve hyperalgesia in the thoracolumbar region
Published in Baylor University Medical Center Proceedings, 2019
Chikamuche T. Anyanwu, Jelix Thomas, Samantha Dayawansa, Stanley H. Kim, Jason H. Huang
A 42-year-old man with a 19-year history of chronic focal hypersensitivity and hyperalgesia with accompanying numbness and tingling at the right T12 to L1 region presented for neurosurgical evaluation. Previous trials of conservative management, including physical therapy, nonsteroidal anti-inflammatory drugs, muscle relaxants, narcotics, and corticosteroid injections, provided minimal to no relief. Hematologic and basic chemistry levels were unremarkable. Recent magnetic resonance imaging of the thoracolumbar spine was remarkable only for age-related disc degeneration (Figure 1d). No underlying subcutaneous mass or neoplasms was observed. A neuroma was suspected and the patient underwent exploration of his posterior right T12 to L1 subcutaneous area. Intraoperative images showed abnormal subcutaneous material with inflamed subcutaneous nerves deep to overlying scar tissue (Figures 1a, 1b). A neurectomy was performed with the nerves and surrounding tissue specimens collected. Microscopic evaluation of the specimens was performed (Figure 1c). Both specimens were negative for neoplasms. Two-week postsurgical follow-up was unremarkable. The patient noted only mild incisional pain at 3/10 on the pain scale.
An investigation of dynamic ulnar impingement after the Darrach procedure with ultrasonography
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Kuan-Jung Chen, Jung-Pan Wang, Hui-Kuang Huang, Yi-Chao Huang
The patients received surgery under general anesthesia. An incision was made on the dorsal side of the wrist, medial to the extensor carpi ulnaris (ECU). Anterior interosseous nerve (AIN) and posterior interosseous nerve (PIN) neurectomy were routinely performed, excising the distal 1–2 cm section. The extensor retinaculum, periosteum, and the distal part of the pronator quadratus (PQ) muscle were elevated to expose the distal ulna. Then ulnar osteotomy was made in a long-sloped shape, and parallel to the contour of the opposing radius. The edges of the ulnar cut were beveled with the saw. The detached distal part of the PQ muscle was transferred dorsally and sutured onto the periosteum sleeve of the ulnar stump, forming an interposition (Figure 2). In the cases with an attritional tear of the extensor tendons, the tendons were explored and reconstructed using the same incision.
Meralgia paresthetica: finding an effective cure
Published in Postgraduate Medicine, 2020
Nerve blocks are a potentially beneficial treatment in MP. However, the evidence is inconclusive. Small case studies have shown that nerve blocks are useful as a treatment for MP, although some cases need repeated injections to provide adequate pain relief. Surgical interventions are arguably very effective in most cases but carry a higher risk. Neurolysis and neurectomy are both adequate treatments with neurectomy achieving an almost complete cure rate. However, neurectomy also creates numbness on the area previously supplied by the LFCN.
Related Knowledge Centers
- Autonomic Nervous System
- Chronic Pain
- Hyperhidrosis
- Hypoesthesia
- Nerve Block
- Peripheral Nervous System
- Sensory Nerve
- Vertigo
- Nerve Decompression
- Cramp