고주파 열응고술을 이용한 요부교감신경 파괴술: 알코올 신경 차단술과의 효과 비교

Abstract

Background: Lumbar sympatholytic block (LSB) is a widely accepted procedure applied to hyperhidrosis, circulatory insufficiency, and sympathetically maintained pain in the lower extremities. The purpose of this study was to compare the therapeutic effects of radiofrequency thermocoagulation (RF) with neurolytic alcohol block (AB) on the lumbar sympathetic nerve system, respectively. Methods: We performed LSB in 69 cases. Under the fluoroscopic guidance, and patients in the lateral or prone position, RF was applied using with a 21 G curved needle with a 10 mm active tip. Lesions were made at two levels, L3 and L4, for 60 seconds at 80 85oC. In AB cases, we used 21 G block needles and injected 3 cc of dehydrated alcohol into each level. We classified therapeutic effects using 5 grades; excellent, good, fair, poor and very poor. We studied success rates, effective duration, and complications. Results: The success rate was 77.8% in RF group and 88.6% in AB group, but this was not statistically different (P> 0.05), and as was effective duration, mean 8.4 vs. 9.4 months. Complications, which occurred only in the AB group, were neuritis (9.0%), hypoesthesia (4.5%), ejaculation failure (2.3%), and dyspareunia (2.3%). Conclusions: We concluded that RF is an effective and safe lumbar sympatholytic methodology for either hyperhidrosis or painful disorders on the lower extremities. However, to improve the success rate, effective duration, and methodology, further prospective studies are required.