MIPSI or Minimally invasive pain and spine interventions is a broad term which encompasses all the Non-invasive and minimally invasive interventions done by the interventional spine and pain physicians for myriad of conditions right from Musculo-skeletal disorders like back pain, neck pain, knee pain etc.
What are the Lumbar Sympathetic ganglion and where are they situated?
In our body, a chain of sympathetic ganglia is present bilaterally on either side of the vertebrae which extend from upper neck down to the coccyx. There are usually 22-23 pairs of these ganglia: 3 in the cervical region, 11 in the thoracic region, 4 in the lumbar region and 4-5 in the sacral region.
Ganglia present at the level of the Lumbar vertebrae are called Lumbar Sympathetic ganglia. They are located at the anterolateral aspect of the vertebrae.
What is the procedure of Lumbar Sympathetic ganglion Radiofrequency neurectomy?
Lumbar Sympathetic ganglion Radiofrequency neurectomy is an advanced procedure which involves the precise placement of the Radiofrequency needles at the level of L2, L3 and L4 vertebrae at the antero- lateral aspect, identification of the ganglion with the help of sensory and motor stimulation and then its targeted ablation using Radiofrequency current.
Whole procedure is done under local anaesthesia with some mild sedation.
What are the Indications of Lumbar Sympathetic ganglion neurectomy?
- Complex Regional Pain Syndrome ( CRPS ) of Lower limb
- Phantom limb pain
- Lower limb vascular insufficiency like Raynaud’s syndrome and Scleroderma
- Post-herpetic neuralgia
- Post-radiation arteritis
- Diabetic neuropathy
- Cancer pain
How Lumbar Sympathetic ganglion neurectomy MIPSI helps relief pain?
Lumbar Sympathetic ganglion Radiofrequency neurectomy mainly acts by 2 mechanisms:
Peripheral Wallerian degeneration of the nerve: Due to the application of Radiofrequency currents , the friction between the various tissue molecules generate thermal energy which burns the nerves and brings about what is called as conduction block. So these nerves stop conducting pain signals from the affected site towards the brain where pain stimulus is actually processed and patient feels immediate relief from pain.
Central neuromodulation: Chronic pain has a component of Central Sensitization where in there is amplification of the pain signals in the brain and patients experience pain even in the absence of any movements or painful stimulus. With application of Radiofrequency ablation there is modulation in these central neural circuitries and the central sensitization is abolished.
How early the beneficial effects can be seen?
Patient can start appreciating the effect of the procedure within 3-4 days and maximal effect is achieved over a period of 3-4 weeks.
How many times this procedure has to be repeated?
The effect of this procedure can last from about 6 months to few years, after which this procedure has to be repeated. During this pain free period patient becomes drug free and thus escapes from the side effects of these medications which occur due to prolonged use of the drugs.
Will I require hospitalization for this procedure?
Yes. Patient generally is hospitalized for a period of 24 hours post-procedure for observation.
To see how this procedure is done, click the below link