Incidence of neuroma after RFA

[dalhousie]

I'm considering having nerve ablations done at the level of my ADR for inflamed & spasmed back muscles. I'm waiting to hear from my specialist with the results of an MRI scan to make sure there is nothing else going on in my spine before he considers embarking on anything destructive.

I discovered that there is a small risk of neuroma with ablations. A spine patient directed me to "The Pain Clinic" website:

"In a small proportion of people permanent nerve pain can result possibly from RF damage to the spinal nerve to the legs. There is no technique to undo this damage, but the pain may be helped by drugs for nerve pain".

I had RFA's done on 5 occasions with my first disc problem in the late 1990's & was never once warned about any such risks. Although I kept having to have the ablation repeated as the nerve grew back I didn't get neuroma. On the last occasion I had RFA at that time I had a longer harsher burn & they were all right after that. I'm hoping techniques will have improved significantly since the late 1990's.

I don't know of anybody who has developed neuroma after RFA but there must be some. I get the impression that the risk is low but it's sod's law it could happen to me. I have such rotten luck with my spine. I just couldn't bear being in worse pain as I feel so fed up & at the end of my tether now.

Anybody any thoughts or advice??

Thanks.

[dalhousie]

P.S. Does anybody know why doing RFA at the level of an ADR would be tricky or problematic - I didn't get chance to ask my specialist why he would say it was tricky & am waiting for him to contact me.

[trkdoc714]

The only thing I can think of is possibly he isn't comfortable that he's isolated the source of your pain yet. I don't think ADR would be a contraindication RFA treatments.

[dalhousie]

The only thing I can think of is possibly he isn't comfortable that he's isolated the source of your pain yet. I don't think ADR would be a contraindication RFA treatments.

I am thinking & hoping that's the reason. When he said it I thought maybe it might affect the implant (activ L) in some way but that was just a wild guess. I did have facet joint injections & my back muscles were much calmer for 2 weeks - I got my painkillers down from 4 to 2 doses (but I was sore from the injections for a week) & was on my feet quite a bit more & able to do more walking. He did say that both he & this other specialist I was under liked to be as sure as possible about the pain source before embarking on anything destructive so that must be the reason. It's just all this hanging about & not knowing. It's quite a trek but I might book an appointment as a last resort so if I don't hear from him in the next few weeks I've got a fall back position.

Thanks for replying. It's reassured me & helped to stop me worrying.

[dalhousie]

I saw my specialist yesterday - my MRI scan appeared OK. Since I got 2 weeks benefit from facet injections at L4/5 - the level of my ADR - the next option would be RFA's at that level. My specialist seemed to sit on the fence about it but as I got 2 week's benefit surely it has a reasonable chance. He performs RFA's on a selective group of patients as he said they work best that way & also said I fit into that category. (I think my specialist was concerned about what if they didn't work but his only other suggestion was fusing over my ADR which I don't want. I'm currently increasing my walking 10 steps/day which is 70 steps/week so it will take a long time but if the worst came to the worst I'd be better sticking with that than resorting to revision surgery). I did tell him this, though).

(In the 1990's I had several RFA's done on a different problem under a not so good specialist & that was when I had little if any result from injections & they worked well on that occasion).

I asked about the risk of neuroma & he said it can happen but with his patients so far, RFA's have either worked or they haven't, nobody has been any worse. From the research papers I've seen so far 1% of minor complications have been reported but no mention of neuroma. I've been left to think it over but I can't help thinking surely it's work a try as the risk is pretty low. I haven't come across anybody who's developed a neuroma. I believe it takes up to 2 years post RFA to develop - it's quite a slow growing benign tumour.

Here's an extract from one below:


Complications of lumbar facet RF Denervation: Kornick, Craig; Scott Kramarich; Lamer, Tim J.; Todd Sitzman. Spine Journal 15 June 2004.

"AB Study Design. Retrospective. Objective. To assess the incidence of complications associated with fluoroscopically guided percutaneous radiofrequency denervation of the lumbar facet joints. Summary of Background Data. Based on the results of previous efficacy studies, complications associated with facet joint radiofrequency denervation procedures appear to be rare. No formal safety assessment for this procedure has been performed to date. Methods. We conducted retrospective chart reviews to identify complications that occurred within 8 weeks of facet joint radiofrequency denervation procedures performed at the Mayo Clinic in Jacksonville during a 5-year period. Only procedures that included radiofrequency electrode placement between the L1 transverse process and the sacral ala were included. The chart of each patient was reviewed and adjudicated by a panel of 4 physicians before being classified as a complication. Results. Ninety-two patients received a total of 616 radiofrequency lesions during 116 separate denervation procedures. An average of 5 +/- 3 lesions were performed during each radiofrequency denervation procedure. Six minor complications were identified, yielding a 1.0% overall incidence of minor complications per radiofrequency site. Complications included: 3 cases of localized pain lasting more than 2 weeks (0.5%) and 3 cases of neuritic pain lasting less than 2 weeks (0.5%). No cases of infection, new motor deficits, or new sensory deficits were identified. Conclusions. Fluoroscopically guided percutaneous radiofrequency denervation of the lumbar facets is associated with an overall 1.0% incidence of minor complications per lesion site".



Any advice would be welcome. I've nobody I can discuss this with sensibly. The risks do seem very low but I have such rotten luck with my back - it's sod's law but if it can go wrong it does - maybe I'm being overly negative!


Please help