Scoliosis is a common condition that is a curvature of the spine. Scoliosis can be congenital (idiopathic) and may run in your family. Other types are neuromuscular or can also be result of degeneration. Neuromuscular scoliosis is associated with certain conditions like muscular dystrophy, spinal cord injury, spina bifida or cerebral palsy where there is an inability to control the muscles that support the spine resulting in scoliosis.
The National Scoliosis Foundation estimates that 2-3% of the population is affected by scoliosis. The diagnosis is often made at the time of adolescents screening in school. Most commonly scoliosis is mild and does not cause any symptoms. If the curve is greater than 25 degrees in adolescents still growing it is followed closely to monitor progression. Severe curvatures can ultimately impact cardiovascular or pulmonary function and for curvatures greater than 50 degrees surgery may be indicated. Adults who have scoliosis often will suffer from more mechanical spine pain than the general population. This is associated with the extra forces placed on the facet joints as a result of the rotation and curvature of the spine. As scoliosis worsens throughout the aging process, the curve may progress and there may also be a compensatory S-shaped where there are two locations of the curvature. This changes the mechanics of the spine causing the shoulders to be uneven and the rotation is evident with a rib hump, shift at the pelvis and one hip may appear higher than the other.
Treatment is focused toward the painful facet joints and musculoskeletal imbalances. There are good non-surgical long term treatment options that can be effective to help minimize the impact of the chronic pain associated with the rotational forces placed on the spine. Similar to treatment for facet arthritis, medial branch blocks are precise nerve blocks that are preformed to identify the painful joints. If the results of the nerve block provide significant relief, radiofrequency ablation can then provide long-term relief. Most insurance companies will cover this treatment at least once a year.
Radiofrequency Ablation is the treatment of choice for many painful areas of spine whether it is a result of arthritis or a painful nerve. In the case of arthritis pain, the medial branch nerve that provides sensation to the painful facet joints is interrupted. Radiofrequency can offer more long term relief of the cervical, thoracic or lumbar region or other peripheral nerves.
What is radiofrequency? Radiofrequency is a safe, minimally invasive procedure using specialized equipment, insulated needle with a probe to deliver high-frequency, low voltage radio waves converted to heat that interrupts and eliminates the sensation of the pain form its source. There are different methods to deliver this electric energy, whether by pulsed (cooled) or heat (continuous) modes. In pulsed radiofrequency the nerve is pulsed to eliminate only the painful aspect while the function of nerve is maintained.
How is radiofrequency preformed? The procedure is performed in an operating room, with fluoroscopy (x-ray) using a specialized radiofrequency machine and equipment. The needle is positioned using bony landmarks that identify the nerves with fluoroscopy (x-ray). The needle is precisely placed within 1mm of the nerve to create an effective lesion. Therefore pinpoint accuracy is important in achieving the best results. Depending on the area treated the procedure may take 30-45 minutes.
Is radiofrequency painful? Patients typically tolerate the procedure very well. The procedure involves inserting a needle through skin and those layers of muscle and soft tissues, so there is some discomfort involved. Conscious sedation is offered to allow more comfort during the procedure as well as local anesthetic to numb the skin and deeper tissues to provide comfort during the needle placement and during the radiofrequency portion of the procedure.
How long does radiofrequency last? The result with radiofrequency may vary depending on the severity of arthritis, progression of arthritis between intervals, and lifestyle choices. Results are also dependent of accurate diagnosis made with nerve blocks that would indicate concordant pain relief and accuracy and precision of preforming the radiofrequency procedure itself. Typically we expect an average of 12 month however can be as short as 6-9 months or as long as 18+ months
Is radiofrequency safe? Radiofrequency is a standard pain management technique that has been used for over 50 years in various regions of the body. Radiofrequency has full FDA clearance. However there are some insurance companies the claim it is “experimental” and not covered despite efforts to provide documentation with multiple peer review literature studies and text book chapters they still find it “experimental.”