Percutaneous radiofrequency thermal lumbar sympathectomy and its clinical use

Percutaneous radiofrequency thermolesion techniques are commonly used in the treatment of chronic pain in different pain syndromes. There are many reports describing techniques of percutaneous radiofrequency thermolesion for denervation of central & spinal nerves (Mullan 1963), 1965, 1971; Rosomoff, 1966, Sweet 1974, Uematsu, 1974). Apart from the report by Pernak (1985) no other clinical studies concerning the use of the radiofrequency electrocoagulation technique for denervation of sympathetic nerves have been reported in the literature. For sympathetic denervation, neurolytic agents or surgical sympathectomy are still commonly performed and these techniques may provide prolonged pain relief (Swerdlow, 1978). Poor results occur when technical difficulties result in an incomplete sympathectomy. Neurolytic sympathectomy, using phenol or alcohol, offers the advantage of short hospitalisation and avoids the risk of surgery and need for anesthesia. Nevertheless, following both surgical and chemical sympathectomy the possibility of complications is always present (Swerdlow, 1978; Rutherford, 1977). Taking this into consideration, we have performed and developed the technique of radiofrequency thermal sympathectomy from 1982 to date. The first presentation of this technique took place at the 1st International Symposium 'The Pain Clinic' (Delft, 1984) and is described in the Proceedings of that symposium (Pernak and v.d. Berg, 1985). Slight modifications to this technique have since been made which will be outlined in this report. Knowledge of the course of the sympathetic innervation provided the idea to perform thermal radiofrequency sympathectomy at the 4th lumbar level only. However, in different pain syndromes radiofrequency sympathectomy can be performed at every level of the spine. Thermal sympathectomy can be used in those pain syndromes where hyperactivity of the sympathetic nerves is obvious. To date, more than 500 percutaneous radiofrequency thermal sympathectomies have been performed in patients with varying pain syndromes. In this study, 210 patients with different pain syndromes were selected and one criterion for selection was that all patients had obvious sympathetic hyperactivity. Percutaneous radiofrequency thermal lumbar sympathectomy (PRTLS) was performed in all these patients. This technique is described and its clinical use in the combined pain treatment of these patients in the Pain Clinic of the Reinier de Graaf Gasthuis in Delft during the period 1983-1986 is discussed. The results and conclusions are presented.

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