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 is Stellate ganglion and where is it situated?
Stellate ganglion, also known as Cervicothoracic ganglion is a Sympathetic ganglion which is formed by the fusion of Inferior Cervical ganglion and First Thoracic ganglion. It is polygonal in shape and is comparatively larger than other thoracic, lumbar or sacral sympathetic ganglia.
It is located at the level of C7 vertebra at the base of the Uncinate process and provides most of the sympathetic innervation of the head, neck, upper arm and portion of upper thorax.
What is the procedure of Stellate ganglion Radiofrequency neurectomy?
stellate ganglion Radiofrequency neurectomy is an advanced procedure which involves the precise placement of the Radiofrequency needle at the base of the uncinate process at C7 level and 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 Stellate ganglion neurectomy?
- Complex Regional Pain Syndrome ( CRPS ) of upper limb
- Phantom limb pain
- Upper limb vascular insufficiency like Raynaud’s syndrome and Scleroderma
- Post-herpetic neuralgia
- Refractory Angina
- Atypical facial pain
- Oral cancer with persistent Oro-facial pain
- Upper limb lymphedema example post- Ca breast surgery.
- Post-radiation arteritis
How Stellate ganglion neurectomy MIPSI helps relief pain?
Stellate 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