Pulsed radiofrequency treatment for trigeminal neuralgia

Pulsed radiofrequency [PRF] treatment is defined as the delivery of short pulses of radiofrequency via a needle tip, which does not result in an actual thermal lesions. There are mixed views regarding the use of PRF for trigeminal neuralgia [TN]. In our opinion, one of the main reasons for the contrasting views is the insufficient PRF dose employed in previous studies. In a recent study on the effects of PRF on resiniferatoxin-induced neuropathic pain in an animal model, the anti-allodynic effects of PRF were significantly greater when the PRF exposure duration was increased from 2 to 6 minutes. The primary objective of this retrospective study is to report the results for 36 consecutive patients who underwent PRF treatment for TN, for 6 minutes at 45 V at a pulsed frequency of 4 Hz and a pulse width of 10 ms. For the study, we obtained procedural records of 36 consecutive patients. Their current state of pain was evaluated over a telephonic survey and the post-procedural data at 2, 6, and 12 months were retrieved thereafter from the patient records. The main outcome measure was excellent pain relief [more than 80%], which was assessed at 2, 6, and 12 months. The percentages of patients who showed excellent pain relief [>/= 80% pain relief] at 2, 6, and 12 months were 73.5% [25/34], 61.8% [21/34], and 55.9% [19/34], respectively. The percentages of patients showing satisfactory pain relief [50-80% pain relief] at 2, 6, and 12 months were 14.7% [5/34], 17.6% [6/34], and 17.6% [6/34], respectively, and those of patients showing less than satisfactory pain relief [< 50% pain relief] at 2, 6, and 12 months were 11.8% [4/34], 20.6% [7/34], and 23.5% [8/34], respectively. No complications were reported, and none of the patients required hospitalization. PRF of the trigeminal ganglion should be further evaluated as an alternative treatment method for TN

Percutaneous Thoracic Intervertebral Disc Nucleoplasty: Technical Notes from 3 Patients with Painful Thoracic Disc Herniations

Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic disc herniation. Two of the patients experienced more than 75% pain relief and one patient experienced more than 50% pain relief. Post-procedural pain relief was maintained up to an average of 10 months after nucleoplasty. One patient with preoperative neurological signs improved postoperatively. There were no reported complications in all three patients. In view of the reduced morbidity and shorter operating time, thoracic intervertebral disc nucleoplasty can be considered in patients with pain due to thoracic disc herniation, with no calcification of the herniated disc, and in patients who may be otherwise be unfit for conventional surgery.