Spinal pain is the most common painful complaint in humans. Cervicalgia, dorsalgia, and lumbalgia are globally the most frequent causes of medical consultations and workplace absenteeism. It is estimated that 85% of the population will experience episodes of low back pain at some point in their lives.
Low back pain can be classified into well-defined clinical conditions: degenerative (due to wear and tear of joint structures), infectious, vertebral fractures, neoplasms, etc., or, in most cases, as nonspecific conditions. These poorly defined cases of axial (central) pain are called mechanical low back pain.
Mechanical low back pain can be classified as either acute or chronic, with the latter referring to symptoms lasting over six months, representing 2-7% of all cases. Risk factors are numerous, including those related to occupation (heavy, repetitive work), posture, obesity, genetic factors, and psychosocial aspects. These factors have a significant influence on chronic and disabling low back pain.
Diagnosis is made through clinical assessment and imaging studies, with magnetic resonance imaging being particularly relevant. The goal of treatment is to relieve pain, restore functionality, and prevent recurrence and chronicity.
Minimally invasive percutaneous intervention techniques, guided by imaging – including Computed Tomography, Fluoroscopy, and Ultrasound – allow the identification, in a considerable percentage of cases, of the anatomical structures involved in the genesis of chronic nonspecific low back pain. The intervertebral discs, facet joints, and sacroiliac joints are the structures most commonly associated with this condition.
These intervention techniques are not limited to diagnosis; they extend to treatment and prognosis, guiding the neurosurgeon to the root cause of the pain, allowing them to treat it in a more targeted manner, such as with radiofrequency.
Radiofrequency is an electromagnetic wave applied through a small-calibre electrode, inserted via a special needle, with only the distal part exposed. When the radiofrequency current is released, it generates heat and an electric field. Thermal radiofrequency is used to treat facet joint pain (at the vertebral facet joints) by causing thermocoagulation of the medial nerve.
Pulsed radiofrequency uses the electric field, but not the thermal effect, to produce analgesia and can have other applications, as it does not cause nerve destruction.
Low back pain originating from the sacroiliac joints can also be treated with radiofrequency.
This radiofrequency intervention was performed by Dr. Leandro Augusto Ribeiro Silva at HPA – Alvor.
25, October 2024
