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Review
. 2021 Sep 8:14:2807-2831.
doi: 10.2147/JPR.S325665. eCollection 2021.

Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN)

David W Lee  1 , Scott Pritzlaff  2   3 , Michael J Jung  2   3 , Priyanka Ghosh  4 , Jonathan M Hagedorn  5 , Jordan Tate  6 , Keith Scarfo  7 , Natalie Strand  8 , Krishnan Chakravarthy  9   10 , Dawood Sayed  11 , Timothy R Deer  12 , Kasra Amirdelfan  13
Affiliations
Review

Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN)

David W Lee et al. J Pain Res. .

Abstract

Radiofrequency neurotomy (RFN), also known as radiofrequency ablation (RFA), is a common interventional procedure used to treat pain from an innervated structure. RFN has historically been used to treat chronic facet-joint mediated pain. The use of RFN has more recently expanded beyond facet-joint mediated pain to peripherally innervated targets. In addition, there has also been the emergence of different radiofrequency modalities, including pulsed and cooled RFN. The use of RFN has been particularly important where conservative and/or surgical measures have failed to provide pain relief. With the emergence of this therapeutic option and its novel applications, the American Society of Pain and Neuroscience (ASPN) identified the need for formal evidence-based guidance. The authors formed a multidisciplinary work group tasked to examine the latest evidence-based medicine for the various applications of RFN, including cervical, thoracic, lumbar spine; posterior sacroiliac joint pain; hip and knee joints; and occipital neuralgia. Best practice guidelines, evidence and consensus grading were provided for each anatomical target.

Keywords: chronic pain; cooled ablation; occipital neuralgia; peripheral joint neurotomy; pulsed ablation; radiofrequency ablation; radiofrequency neurotomy; sacroiliac joint neurotomy.

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Conflict of interest statement

Dr David W Lee reports grants from Abbott, during the conduct of the study; is a member of speakers Bureau for Abbott Neuromodulation, outside the submitted work. Dr Scott Pritzlaff reports personal fees from Nalu Medical, personal fees from EBT Medical, personal fees from SPR Therapeutics, outside the submitted work. Dr Jonathan M Hagedorn reports personal fees from Abbott, personal fees from Boston Scientific, personal fees from Nevro, personal fees from Speranza Therapeutics, outside the submitted work. Dr Jordan Tate reports personal fees from Abbott. Dr Dawood Sayed reports personal fees from Abbott, personal fees from Medtronic, personal fees from Nevro, PainTeq, Spr, and Vertos, during the conduct of the study. Dr Timothy R Deer reports personal fees from Abbott; also his institution research received funding from Avanos, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Lesioning performed in chicken breast (37°C). Left probe, Cooled RF 18G with 4mm active tip, set temperature of 60°C. Right probe, Standard RF with 20G with 5mm active tip, set temperature 80°C. Arrow annotates the location of the probe tips. Used with permission from Avanos Medical, Inc.
Figure 2
Figure 2
Axial and lateral illustrations of optimal radiofrequency needle placement for both parasagittal and oblique passes.
Figure 3
Figure 3
Variation in the position of the thoracic medial branches. Reproduced with permission from Bogduk N (ed). Practice Guidelines for Spinal Diagnostic and Treatment Procedures, 2nd edn. International Spine Intervention Society, San Francisco, 2013.
Figure 4
Figure 4
Illustration showing optimal radiofrequency needle placement parallel to the lumbar medial branch nerve.
Figure 5
Figure 5
Radiofrequency cannulae placement for palisade technique.
Figure 6
Figure 6
Radiofrequency cannulae placement for peri-foraminal technique.
Figure 7
Figure 7
Anteroposterior (AP) view of the knee showing placement of radiofrequency needles along the trajectory of the superolateral, superomedial and the inferomedial genicular branches.
Figure 8
Figure 8
Fluoroscopy image of RFN cannulae placement targeting the articular branches of the ON and FN. The articular branches of the FN are located inferior and medial to the anterior inferior iliac spine. The ON branches run just inferior to the incisura acetabuli. A lateral to medial approach is shown - a technique that aims to avoid the femoral neurovascular bundle. The yellow ovals denote neurotomy location.
Figure 9
Figure 9
Illustration of optimal radiofrequency needle placement.
See this image and copyright information in PMC

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