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Dr Menno Sluijter is an Emeritus Professor at Maastricht University, the Netherlands. He pioneered radiofrequency techniques in the 1980s and 1990s, teaching many doctors from all over the world. He is the author of two books on the subject. He is now working as a consultant at the Institute for Anesthesiology and Pain at the Swiss Paraplegic Center, Nottwil, Switzerland. Dr Sluijter is an honorary member of the Dutch Society of Anesthesiologists. He has been honoured for his work by the Noordenbos Award from the Dutch Pain Society and by the Moricca Award from the Italian Pain Society.
Radiofrequency ablation in the management of spinal pain

Menno E. Sluijter MD, PhD
Consultant, Institute for Anesthesiology and Pain Treatment, Swiss Paraplegic Center, Nottwil, Switzerland

Address for correspondence:
Menno E. Sluijter
Institute for Anesthesiology and Pain Treatment
Swiss Paraplegic Center
CH 6207 Nottwil, Switzerland
Phone: +41-41-9394910
Fax: +41-41-3121114
Email: msluijter@mac.com

Abstract
Radiofrequency treatment has traditionally been regarded as an ablative method, blocking the conduction of nociceptive stimuli to the spinal cord. This concept has been challenged and the mode of action may not be exclusively thermal. This has led to the development of pulsed radiofrequency, with a reduced destructive effect.

Indication Radiofrequency treatment is indicated for pain with a constant and limited distribution. Neuropathic pain can be treated if the function of the relevant nerve is still partially intact.

Diagnosis A clinical diagnosis must be made first to exclude conditions that require a different form of treatment. The diagnosis is then confirmed by diagnostic nerve blocks.

Technique Positioning of the electrode should be monitored radiologically, either by computed tomography (CT)-guidance or by fluoroscopy. Once the electrode is in place, the correct position is confirmed by electrostimulation.

Results The efficacy has been confirmed by a number of randomised controlled trials (RCTs) for heat radiofrequency and by one RCT for pulsed radiofrequency. Reported results vary from 60 to 90%. There is a tendency for recurrence within 1–2 years, but the procedure can be repeated.

Complications Serious complications are very rare.

Conclusion Radiofrequency treatment is a relatively safe, well-tolerated technique to treat selected cases of chronic pain.