Lumbar Facet Syndrome and the Use of Radiofrequency Ablation Technique as an Alternative Therapy: A Systematic Review / Síndrome facetária lombar e a utilização da técnica de ablação por radiofrequência como terapia alternativa: uma revisão sistemática

Abstract Lumbar facet syndrome stands out as a significant cause for the increasing prevalence of back pain complaints. Alternatives such as radiofrequency (RF) ablation may be a therapeutic option to relieve the chronic pain associated with this condition. It is critical to analyze the effectiveness of lumbar facet syndrome treatment using the traditional RF ablation technique and the relief generated by it in chronic low back pain (CLBP). This study is a systematic review using the following inclusion criteria: title, observational studies, clinical trials, controlled clinical trials, clinical studies, and publications over the last 17 years (from 2005 to 2022). The exclusion criteria included papers addressing other themes and review articles. The databases used for data collection included the Medical Literature Analysis and Retrieval System Online (Medline), PubMed, Scientific Electronic Library Online (SciELO), Lilacs, and Biblioteca Virtual em Saúde (Virtual Health Library in Portuguese). The query used the following terms: facet, pain, lumbar, and radiofrequency. The application of these filters yielded 142 studies, and 12 were included in this review. Most studies indicated that the traditional RF ablation technique was beneficial in relieving CLBP refractory to conservative treatment.

Resumo Em um contexto de aumento da prevalência de queixas de dores na coluna, a síndrome facetária se destaca como um importante causador. Alternativas como a ablação por radiofrequência (RF) podem ser uma opção de terapia para alívio da dor crônica que essa patologia pode causar. É necessário analisar a eficácia do tratamento da síndrome facetária pela técnica de ablação por radiofrequência tradicional e o alívio gerado nas dores lombares crônicas (DLC). O presente estudo trata-se de uma revisão sistemática cujo os critérios de inclusão para análise foram: título; estudos observacionais; ensaios clínicos; ensaio clínico controlado; estudos clínicos e publicação nos últimos dezessete anos (2005-2022). Já os critérios de exclusão foram: artigos que abordavam outras temáticas e artigos de revisão. As bases utilizadas para coleta de dados incluíram Medical Literature Analysis and Retrieval System online (Medline), Pubmed, Scientific Electronic Library Online (SciELO), Lilacs, Biblioteca Virtual em Saúde. Os termos utilizados para a pesquisa foram: facet; pain; lumbar; radiofrequency. Aplicando-se os filtros foram encontrados 142 estudos, 12 foram incluídos. Os estudos em sua maioria apontaram ser benéfica a técnica de ablação por radiofrequência tradicional no alívio das dores lombares crônicas refratárias ao tratamento conservador.

Rinofima: reporte de un caso de Clínica Estrella / Rhinophyma: a case report of Clínica Estrella

La rinofima es una patología que se caracteriza por presentar hipertrofia de las glándulas sebáceas con proliferación de tejido fibroso, donde la nariz toma un aspecto lobulado dando como resultado la deformidad de la punta nasal; es una forma de rosácea. La prevalencia de esta variedad de rosácea es de aproximadamente un 5-7% en la población y con predominio en el sexo masculino de la quinta a séptima década de vida. Su etiología no se conoce con exactitud. Se presenta el caso de un paciente masculino de 84 años, con antecedentes patológicos de hipertensión arterial e hipotiroidismo; su lesión inició hace 10 años, como una lesión eritematosa con presencia de telangiectasia a nivel de alas y punta nasal, no dolorosa. Se realizó tratamiento con bisturí frío y radiofrecuencia, se realizaron cortes transversales hasta dejar el lecho desprovisto del tumor y finalmente se usó radiofrecuencia en toda la superficie de la lesión restante. Se realizó el procedimiento ambulatorio sin complicaciones inmediatas o tardías

Rhinophyma is a pathology characterized by hypertrophy of the sebaceous glands with proliferation of fibrous tissue, the nose has a lobed appearance, as a result there is a deformity of the nasal tip; rhinophyma is a form of rosacea. The prevalence of this variety of rosacea is approximately 5-7% in the population and predominantly in males from the fifth to seventh decade of life, the etiology is not well known, however there are several predisposing genetic and environmental factors. We present the case of an 84-year-old male patient with a pathological history of arterial hypertension and hypothyroidism; his lesion began 10 years ago, as an erythematous lesion with presence of telangiectasia in the wings and nasal tip, not painful. Treatment was performed with a cold scalpel and radiofrequency, transverse cuts were made until the tumor was gone, and finally radiofrequency was used on the entire surface of the remaining lesion. The outpatient procedure was performed without immediate or late complications.

Tratamiento endoscópico para el reflujo gastroesofágico / Endoscopic treatment of gastroesophageal reflux

Resumen Durante las últimas 2 décadas se han desarrollado una serie de nuevos tratamientos endoscópicos para el tratamiento de la enfermedad por reflujo gastroesofágico (ERGE) como alternativas al tratamiento médico o funduplicatura quirúrgica. Estos dispositivos incluyen aplicación de tratamiento por radiofrecuencia (Stretta), plicatura endoscópica (EndoCinch, Plicator, Esophyx, MUSE) e inyección o implantación de biomateriales (Enteryx, Gatekeeper, Plexiglas, Duragel). Su objetivo es el alivio de los síntomas creando una barrera anatómica antirreflujo. En esta revisión del tema consideramos artículos indexados en Pubmed, Medline y Scielo en los últimos 10 años revisando un total de 55 trabajos. Evaluamos críticamente los resultados reportados, faltan datos a largo plazo superiores a 10 años. Estos procedimientos reducen el uso de inhibidores de la bomba de protones en cerca del 50%. Evaluaciones subjetivas reportan mejoría de la calidad de vida y satisfacción del paciente. Sin embargo, la evaluación objetiva con endoscopia, manometría, radiología y pHmetría son escasos y si los hay, no muestran cambios significativos. No existe evidencia convincente para adoptar estos métodos como tratamiento definitivo y, por lo tanto, la fundoplicatura por vía laparoscópica sigue siendo el estándar de oro para el tratamiento de la enfermedad por reflujo gastroesofágico.

During the last 2 decades, new endoscopic treatments have been developed for the treatment of gastroesophageal reflux disease (GERD) as alternatives to medical treatment or surgical fundoplication. These devices include application of radiofrequency treatment (Stretta), endoscopic plication (EndoCinch, Plicator, Esophyx, MUSE) and injection or implantation of biomaterials (Enteryx, Gatekeeper, Plexiglas, Duragel). Its objective is the relief of symptoms by creating an anatomical anti-reflux barrier. In this review, we consider articles indexed in Pubmed, Medline and Scielo in the last 10 years, reviewing a total of 55 papers, we analyse critically the reported results, although long-term data greater than 5 or 7 years are lacking. These procedures reduce the use of proton pump inhibitors by about 50%. Subjective evaluations report improvement in quality of life and patient satisfaction. However, objective evaluation with endoscopy, manometry, radiology and pHmetry are scarce and if there are, they do not show significant changes. There is no convincing evidence to adopt these methods as definitive treatment. Therefore, laparoscopic fundoplication is the gold standard for the treatment of gastroesophageal reflux disease.

A radiofrequência fracionada no tratamento de líquen escleroso vulvar: um relato de caso / Fractional radiofrequency in the treatment of vulvar lichen sclerosus: a case report

O líquen escleroso vulvar (LEV) é uma doença dermatológica crônica de etiologia incerta, caracterizada por prurido intenso e atrofia progressiva. O corticosteroide tópico de longo prazo é o tratamento de primeira linha para LEV. No entanto, esse tratamento requer a colaboração da paciente, está associado a efeitos colaterais adversos e algumas pacientes não respondem aos corticosteroides. O tratamento com tecnologias térmicas e fototérmicas tem sido estudado como terapia alternativa ou complementar para melhorar os sintomas de LEV e o trofismo cutâneo. A radiofrequência fracionada microablativa é usada em dermatologia para melhorar o trofismo tecidual. Também tem sido usada em pacientes ginecológicas para tratar a atrofia vulvovaginal, estimulando a neocolagênese dérmica e a neoelastogênese. Apresentamos o caso de uma mulher de 39 anos com LEV refratária que foi tratada com aplicações locais de radiofrequência fracionada microablativa. Ela apresentou melhora satisfatória dos sintomas e do trofismo vulvar em longo prazo, sem necessidade do uso de corticosteroides.(AU)

Vulvar lichen sclerosus (VLS) is a chronic dermatological disease of unclear etiology characterized by severe itching and progressive atrophy. Long-term topical corticosteroid is the first-line treatment for VLS. However, this treatment requires patient compliance, is associated with adverse side effects, and some patients do not respond to corticosteroids. Treatment with thermal and photothermal technologies have been studied as alternative or complementary therapies to improve VLS symptoms and skin trophism. Microablative fractional radiofrequency (MFR) is used in dermatology to improve tissue trophism. It has also been used in gynecological patients to treat vulvovaginal atrophy by stimulating dermal neocollagenesis and neoelastinogenesis. We present the case of a 39-year-old woman with refractory VLS who was treated with local applications of microablative fractional radiofrequency. She had satisfactory, long-term, improvement of symptoms and vulvar trophism, and stopped using corticosteroids.(AU)

Radiofrequency versus scalpel incision for upper blepharoplasty: a clinicopathologic and photo documentation comparison / Radiofrequencia versus lâmina fria em blefaroplastia superior: comparação clinicopatológica e foto documentação

Abstract Objective: The aim of this study is to compare scar appearance and the histopathological aspects of inflammatory response induced by the use of radiofrequency [RF] incision and a cold-blade scalpel incision in upper blepharoplasty surgery. Methods: This is a comparative, prospective, double-blind study that recruited 10 Caucasian patients from Oculoplastic Sector of Ophthalmological Center of Minas Gerais (Belo Horizonte, MG, Brazil) aged 60-70 years, Fitzpatrick skin types 3 and 4, with upper eyelid dermatochalasis and indication for upper blepharoplasty. These patients underwent upper blepharoplasty using RF incision in one eyelid (10 eyelids in total) and cold-blade incision in the contralateral eyelid (10 eyelids in total). The two techniques were compared for clinical scar appearance and histopathology of the excised tissue materials (i.e., upper eyelid skin). To evaluate clinical scar appearance, we employed two distinct methods: photo-documentation and statistical analysis of the assessment performed by two masked observers (oculoplastic specialists) that examined all patients during all the follow-up based on Vancouver scar scale criteria, which includes attributes related to scar's vascularization, thickness, pigmentation, and elasticity. Follow-up was performed on days 30, 60, and 180 after surgery. After the follow-up period, the collected data were statistically analyzed by using the Wilcoxon signed-rank test. Results: The eyelids incised with a scalpel displayed thicker scars (hypertrophic scars), which differed significantly only in the first month after surgery (p = 0.022). The two surgical techniques did not show statistically significant difference in vascularity, elasticity, or pigmentation of the scar during the follow up period (sixth postoperative month). Regarding the histopathological evaluation, the excised skin fragments exhibited the same patterns, except the cautery effect that was observed at the edges of the skin excised with RF, which showed 0.20-0.30-mm thick thermal damage. Conclusion: The two techniques did not show statistically significant difference in terms of scar appearance after the sixth postoperative month.

Resumo Objetivo: Este estudo comparou o aspecto da cicatriz e histopatologia da resposta inflamatória induzidas pelo uso de radiofrequência [RF] e incisão fria em blefaroplastia superior. Métodos: Trata-se de um estudo comparativo, prospectivo, duplo-cego, no qual foram selecionados dez pacientes da raça branca do Departamento de Plástica Ocular do Centro Oftalmológico de Minas Gerais, na faixa etária entre 60-70 anos, fototipos 3 e 4 pela classificação Fitzpatrick, que apresentavam dermatocalase com indicação de blefaroplastia superior. Estes pacientes foram submetidos à blefaroplastia superior com a utilização da RF em uma pálpebra (total de 10 pálpebras) e de incisão fria na pálpebra contralateral (total de 10 pálpebras). As duas técnicas foram comparadas quanto ao aspecto clínico da cicatriz e avaliação histopatológica do material excisado (pele de pálpebra superior). Para avaliação do aspecto clínico da cicatriz optamos por dois métodos: a fotodocumentação e análise estatística da avaliação de dois observadores oculoplásticos mascarados que examinaram os pacientes durante todo o período de follow-up baseado na escala de cicatrização de Vancouver que inclui atributos relacionados à vascularização, espessura, pigmentação e elasticidade. O seguimento foi feito com 30, 60 e 180 dias de pós operatório. Após o follow-up, foi realizada análise estatística dos dados através do Teste de Pontos com Sinais de Wilcoxon. Resultados: As pálpebras operadas com bisturi apresentaram tendência a cicatrizes mais grossas (hipertróficas) com diferença estatisticamente significativa apenas para o primeiro mês de cirurgia (p=0.022). Não houve diferença estatisticamente significativa entre vascularização, elasticidade e pigmentação entre as duas técnicas de cirurgia avaliadas. Em relação à avaliação histopatológica, os fragmentos de pele excisados apresentaram o mesmo padrão inflamatório com a exceção do efeito de cautério nas bordas das peles excisadas com RF, que variaram de 0,20-0,30mm de espessura de dano térmico. Conclusão: As duas técnicas não mostraram diferença estatisticamente significativa no aspecto clínico da cicatriz após o sexto mês pós-operatório.

Tratamiento artroscópico del osteoma osteoide en el astrágalo / Arthroscopic treatment of osteoid osteoma in the talus

Introducción: El osteoma osteoide (OO) es el tumor osteoblástico benigno más frecuente. La ubicación en el astrágalo es del 2 al 10%. La resección es la única opción curativa. Presentamos una serie de 2 casos de osteoma osteoide en cuello del astrágalo con resección artroscópica y radiofrecuencia como tratamiento. Material y Métodos: Presentamos dos pacientes de 23 y 24 años, con dolor crónico en tobillo e imágenes por tomografía y resonancia compatibles con osteoma osteoide. Resultados: Los pacientes evolucionaron favorablemente, con una mejoría notable del score AOFAS, recuperación completa del cuadro y sin recidivas a los 18 meses de seguimiento. Discusión: El diagnóstico suele ser tardío, siendo el primer síntoma el dolor de predominio nocturno y que alivia con el uso de salicilatos. La extirpación artroscópica del OO del tobillo puede ser un procedimiento exitoso con mínimas complicaciones, siendo el tumor fácil de localizar y visualizar. Conclusión: Obtuvimos resultados satisfactorios para el paciente, con tiempos de recuperación breves y menor riesgo de infección. El procedimiento muy recomendable. Tipo de estudio: Serie de casos. Nivel de Evidencia: V

Introduction: Osteoid osteoma (OO) is the most frequent benign osteoblastic tumor. The location in the talus is 2 to 10%. Resection is the only curative option. We present arthroscopic resection and use of radiofrequency as treatment. Material and methods: We present two patients aged 23 and 24 years, with chronic ankle pain, computed tomography and magnetic resonance images compatible with osteoid osteoma. Results: Patients showed complete recovery after procedures, with an notable improvement of AOFAS and no recurrence after a follow-up of 18 months. Discussion: Late diagnosis is usually due to the first symptom being a pain, with nocturnal predominance and relieved by the use of salicylates. Arthroscopic removal of the OO of the ankle can be a successful procedure with minimal complications, being easy to locate and completely visualize the tumor. Conclusion: We obtained satisfactory postoperative results, with short recovery times and decreased risks of infection. We highly recommend the procedure. Type of study: Case series. Level of Evidence: V

Radiofrequency Microtenotomy with Concurrent Gastrocnemius Recession Improves Postoperative Vitality Scores in the Treatment of Recalcitrant Plantar Fasciitis

INTRODUCTION@#Gastrocnemius recession and radiofrequency microtenotomy treat plantar fascia via different mechanisms. While studies have shown additive effects in performing plantar fasciotomy in conjunction with gastrocnemius recession, no such study exists examining the effects of performing radiofrequency microtenotomy with gastrocnemius recession. We hypothesised that performing both gastrocnemius recession and radiofrequency microtenotomy concurrently for recalcitrant plantar fasciitis is more effective than performing either procedure individually.@*MATERIALS AND METHODS@#We analysed all patients who underwent either a radiofrequency microtenotomy, a gastrocnemius recession, or both procedures concurrently between 2007 and 2014. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the SF-36 Health Survey, and 2 questions regarding patient satisfaction and met expectations were assessed preoperatively and postoperatively up to 1-year.@*RESULTS@#Patients who underwent both procedures concurrently had significantly higher vitality scores on the SF-36 Health Survey at 1-year postoperatively compared to patients who underwent either procedure individually. Type of intervention offered and preoperative factors were not predictive for patient outcomes.@*CONCLUSION@#Combining radiofrequency microtenotomy and gastrocnemius recession in patients with recalcitrant plantar fasciitis and an underlying gastrocnemius contracture shows favourable medium- term outcomes compared to performing either procedure in isolation.

New therapeutic option in genitourinary syndrome of menopause: pilot study using microablative fractional radiofrequency / Nova opção terapêutica na síndrome geniturinária da menopausa: estudo piloto utilizando radiofrequência fracionada microablativa

ABSTRACT Objective: To evaluate the clinical response of patients with symptoms of genitourinary syndrome of menopause after application of microablative fractional radiofrequency in the vagina and vaginal introitus. Methods: Fourteen patients with symptoms of genitourinary syndrome of menopause underwent three applications of microablative fractional radiofrequency with a 30-day interval, using the Wavetronic 6000HF-FRAXX device and a fractional vaginal electrode. The questionnaires World Health Organization Quality of Life (for quality of life evaluation), Female Sexual Function Index and Quality of Life Adapted Questionnaire in the Domain of Sexual Satisfaction (for sexual function and satisfaction evaluation) were administered before and after the applications (30 to 60 days after the last procedure), in addition to the satisfaction questionnaire after procedure. Results: There was an increase in almost all dimensions on average in quality of life, with statistical significance only in the health domain. There was a significant improvement in the sexual domains in almost all dimensions. All patients stopped using lubricant during intercourse after treatment. In the satisfaction questionnaire after treatment, we observed that the vast majority felt cured or much better (29% and 64%, respectively, total of 92.6%) and were very satisfied or satisfied (43 and 57%, respectively, total of 100%). The only patient who reported little improvement had an 18-year postmenopausal history and was treatment naïve. Conclusion: Microablative fractional radiofrequency was effective in treating symptoms of vaginal dryness and dyspareunia, and eliminated the use of vaginal lubricant during the period observed. Since this is a pilot study with a small number of patients, further studies are required to corroborate our findings and evaluate the long-term effects of microablative fractional radiofrequency on the vaginal tissue.

RESUMO Objetivo: Avaliar resposta clínica de pacientes com sintomas da síndrome geniturinária da menopausa após aplicação de radiofrequência fracionada microablativa na vagina e no introito vaginal. Métodos: Quatorze pacientes com sintomas de síndrome geniturinária da menopausa foram submetidas a três aplicações de radiofrequência fracionada microablativa com intervalo de 30 dias, utilizando aparelho Wavetronic 6000HF-FRAXX e eletrodo vaginal fracionado. Foram aplicados os questionários World Health Organization Quality of Life (para avaliar qualidade de vida), Female Sexual Function Index e Quality of Life Adapted Questionnaire in the Domain of Sexual Satisfaction (para verificar função sexual e satisfação) antes e depois das aplicações (30 a 60 dias após último procedimento), além do questionário de satisfação após procedimento. Resultados: Na qualidade de vida, houve aumento na média em geral, com significância estatística apenas no quesito saúde. No domínio sexual, houve melhora significativa em quase todas as dimensões. Todas as pacientes cessaram o uso de lubrificante na relação sexual após o tratamento. No questionário de satisfação após tratamento, a maioria se sentiu curada ou muito melhor (29 e 64%, respectivamente; total de 92,6%) e estava muito satisfeita ou satisfeita (43 e 57%, respectivamente; total de 100%). A única paciente que relatou pouca melhora tinha história de 18 anos de pós-menopausa e era virgem de tratamento. Conclusão: Radiofrequência fracionada microablativa foi efetiva em tratar sintomas de ressecamento vaginal e dispareunia, e eliminou o uso de lubrificante vaginal durante o período observado. Por se tratar de estudo piloto com pequena quantidade de pacientes, mais estudos são necessários para corroborar estes achados e avaliar os efeitos a longo prazo da radiofrequência fracionada microablativa no tecido vaginal.

New concept for treating female stress urinary incontinence with radiofrequency

ABSTRACT Purpose: To evaluate the clinical response and adverse effects of radiofrequency on the urethral meatus in the treatment of stress urinary incontinence in women. Materials and Methods: This phase one study included ten women with Stress Urinary Incontinence (SUI). The evaluation consisted of 1 hour Pad tests to quantify urine loss and to assess the degree of procedure satisfaction by using the Likert scale. To evaluate safety, we observed the number of referred side effects. Results: Average age was 53.10 years±7.08 years. In assessing the final Pad Test, 70% showed a reduction and 30% a worsening of urinary loss. Using the Pad Test one month later, there was a reduction in all patients (p=0.028). The degree of satisfaction was 90% and no side effects have been observed. One patient reported burning sensation. Conclusion: The treatment of SUI with radiofrequency on the urethral meatus has no adverse effects, being a low risk method that reduces urinary loss in women. However, to increase the validity of the study, larger clinical trials are warranted.

Efeitos da radiofrequência no rejuvenescimento facial: estudo experimental / Effects of radiofrequency in facial rejuvenation

Introdução: A radiofrequência é um recurso que têm sido frequentemente utilizados na prática clínica para o tratamento da flacidez facial e aparecimento de rugas. Objetivo: Investigar os efeitos da radiofrequência no rejuvenescimento facial. Métodos: Trata-se de um ensaio clínico controlado. A amostra foi composta por 40 voluntárias do sexo feminino, com a faixa etária entre 35 a 55 anos, dispostos em 02 grupos, sendo grupo controle e grupo tratado com radiofrequência. Resultados: Nos valores individuais das medidas do ângulo do sulco nasogeniano é possível verificar um aumento e consequente melhora da qualitativa da flacidez facial. Conclusão: A radiofrequência promoveu uma melhora clínica ao nível do ângulo do sulco nasogeniano. (AU)

Introduction: Radiofrequency is a feature that has been frequently used in clinical practice for the treatment of facial flaccidity and appearance of wrinkles. Objective: To investigate the effects of radiofrequency on facial rejuvenation. Methods: This is a controlled clinical trial. The sample consisted of 40 female volunteers, with the age group between 35 and 55 years, arranged in 02 groups, being the control group and the group treated with radiofrequency. The control conducted 2 months of guidance on skin care and exercises for facial flaccidity. Results: Increase quality improvement of facial flaccidity In the treated group, but statistically there was no result in the comparison between groups. Conclusion: In the qualitative analysis, it was verified that the radiofrequency promoted a clinical improvement at the angle of the nasogenian sulcus. (AU)