Os autores apresentam t\u00e9cnica minimamente invasiva para o tratamento da dor\u00a0lombar cr\u00f4nica, relacionada \u00e0 s\u00edndrome facet\u00e1ria atrav\u00e9s do uso da denerva\u00e7\u00e3o facet\u00e1ria\u00a0com radiofrequ\u00eancia<\/p>\n
Palavras-chave:<\/strong>\u00a0Dor lombar baixa, radiofreq\u00fc\u00eancia percut\u00e2nea, s\u00edndrome facet\u00e1ria, redu\u00e7\u00e3o da dor.<\/p>\n INTRODU\u00c7\u00c3O<\/strong><\/p>\n Dor lombar baixa \u00e9 um problema de sa\u00fade p\u00fablica muito prevalente, atingindo\u00a0cerca de 80% das pessoas durante a vida.1-6 Estudos epidemiol\u00f3gicos mostram que 60%\u00a0desses pacientes tem dor recorrente.7-9 Dentre os fatores que geram dor lombar a articula\u00e7\u00e3o\u00a0facet\u00e1ria \u00e9 respons\u00e1vel por dor lombar em 15%-45% dos pacientes.9-16<\/p>\n Como todas as articula\u00e7\u00f5es do corpo, as facetas est\u00e3o expostas a altera\u00e7\u00f5es degenerativas,\u00a0sendo assim geradoras de dor. A dor facet\u00e1ria \u00e9 conduzida para a medula\u00a0atrav\u00e9s do ramo medial dorsal originado no n\u00edvel da articula\u00e7\u00e3o e no n\u00edvel acima. A\u00a0denerva\u00e7\u00e3o visa o bloqueio desse ramo atrav\u00e9s da radiofreq\u00fc\u00eancia.17-30<\/p>\n Esse artigo visa descrever a t\u00e9cnica de denerva\u00e7\u00e3o facet\u00e1ria atrav\u00e9s da radiofreq\u00fc\u00eancia\u00a0de maneira percut\u00e2nea.<\/p>\n INDICA\u00c7\u00d5ES<\/strong><\/p>\n \u2022 Dor local em 1 ou mais facetas<\/p>\n \u2022 Dor lombar agravada por hiperextens\u00e3o e rota\u00e7\u00e3o do tronco<\/p>\n \u2022 Rigidez matinal<\/p>\n \u2022 Dor no quadril e nadegas sem padr\u00e3o radicular<\/p>\n CONTRA-INDICA\u00c7\u00d5ES<\/strong><\/p>\n \u2022 Dor com padr\u00e3o radicular.<\/p>\n \u2022 Claudica\u00e7\u00e3o neurog\u00eanica<\/p>\n \u2022 Rea\u00e7\u00e3o al\u00e9rgica a anest\u00e9sicos<\/p>\n \u2022 Gestante ou mulher amamentando<\/p>\n \u2022 Pacientes previamente operados da coluna<\/p>\n \u2022 Pacientes diab\u00e9ticos e com mais de uma s\u00edndrome dolorosa<\/p>\n \u2022 Paciente com dist\u00farbio de coagula\u00e7\u00e3o.<\/p>\n PLANEJAMENTO PR\u00c9 OPERAT\u00d3RIO<\/strong><\/p>\n No exame f\u00edsico pr\u00e9 operat\u00f3rio \u00e9 importante a avalia\u00e7\u00e3o neurol\u00f3gica do paciente\u00a0constatando a aus\u00eancia de d\u00e9ficit nos membros inferiores ou radiculopatia, e a localiza\u00e7\u00e3o\u00a0da dor na coluna no n\u00edvel acometido, para preenchermos os quesitos necess\u00e1rios\u00a0para a realiza\u00e7\u00e3o do procedimento.<\/p>\n Paciente deve ter hist\u00f3ria de dor lombar cr\u00f4nica acima de 12 meses, refrat\u00e1ria ao\u00a0tratamento conservador por m\u00e9todos f\u00edsicos e farmacol\u00f3gicos, idade entre 18 e 65 anos,\u00a0score de no m\u00ednimo 4 na escala anal\u00f3gica da dor, exame de imagem compat\u00edvel com\u00a0acometimento da articula\u00e7ao zigoapofis\u00e1ria (TC ou IMR) e teste do bloqueio facetario\u00a0anest\u00e9sico com lidoca\u00edna positivo).<\/p>\n Nosso grupo tem por rotina solicitar RNM da coluna vertebral que evid\u00eancia artrose\u00a0facet\u00e1ria e excluem outras patologias (h\u00e9rnia discal, estenose de canal, tumor, fratura\u2026)<\/p>\n O procedimento necessita ser feito no centro cir\u00fargico com instrumental cir\u00fargico\u00a0adequado, mesa cir\u00fargica radiotransparente e intensificador de imagem.<\/p>\n T\u00c9CNICA CIR\u00daRGICA<\/strong><\/p>\n O paciente \u00e9 colocado na posi\u00e7\u00e3o prona ap\u00f3s inala\u00e7\u00e3o do anest\u00e9sico e suplementa\u00e7\u00e3o\u00a0com narc\u00f3ticos. A mesa deve ser radiotransparente para permitir a imagem no\u00a0\u00e2ntero-posterior (AP) e perfil (P) dos corpos vertebrais envolvidos (Figura 1).<\/p>\n A pele \u00e9 preparada com solu\u00e7\u00e3o degermante e tintura de iodo. O paciente \u00e9 protegido\u00a0pelos campos est\u00e9reis. Inicialmente uma agulha de 22 gauge x 90 mm \u00e9 utilizada como marcador,\u00a0atrav\u00e9s da radioscopia, para localizar o ponto entre o processo transverso e a faceta\u00a0articular superior, onde se localiza o ramo medial da raiz dorsal. Para isso o arco deve ser\u00a0rodado cerca de 15\u00b0 lateralmente partindo se do AP, e angulado cerca de 20\u00b0 para caudal\u00a0permitindo a vis\u00e3o do ponto alvo, o que possibilitara a visualiza\u00e7\u00e3o mais n\u00edtida da borda\u00a0do processo transverso (Figura 2).<\/p>\n O pr\u00f3ximo passo ser\u00e1 o bloqueio da pele e subcut\u00e2neo\u00a0com solu\u00e7\u00e3o de lidoca\u00edna a 1% na proje\u00e7\u00e3o do alvo a ser atingido (Figura 3).<\/p>\n Uma c\u00e2nula\u00a0de 16-gauge \u00e9 utilizada para pun\u00e7\u00e3o no local anestesiado e introduzida at\u00e9 o ponto alvo. Um\u00a0eletrodo de 16-gauge \u00e9 utilizado atrav\u00e9s da c\u00e2nula com exposi\u00e7\u00e3o de 5 mm de sua por\u00e7\u00e3o\u00a0ativa, iniciando o contato atrav\u00e9s do ponto onde a borda caudal do processo transverso encontra\u00a0a faceta articular superior, sendo progredido em dire\u00e7\u00e3o a borda superior (Figura 4).<\/p>\n A incid\u00eancia anteroposterior (AP) \u00e9 utilizada para checar o posicionamento do eletrodo junto ao processo articular superior (Figura 5).<\/p>\n A incid\u00eancia em perfil \u00e9 utilizada para garantir que o topo do eletrodo n\u00e3o ultrapasse ventralmente o processo tranverso (Figura 6). A incid\u00eancia obliqua \u00e9 utilizada para checar o paralelismo da agulha em rela\u00e7\u00e3o ao trajeto do nervo.<\/p>\n Com o gerador de radiofreq\u00fc\u00eancia o eletrodo \u00e9 utilizado para estimular o trajeto do nervo, com um pulso de 1mseg, 5 Hz de freq\u00fc\u00eancia e uma voltagem m\u00ednima que permita a estimula\u00e7\u00e3o do mult\u00edfido (Figura 7). O eletrodo deve ser reposicionado e checado nas tr\u00eas incid\u00eancias caso n\u00e3o ocorra a estimula\u00e7\u00e3o da musculatura com 0.5 V ou menos.<\/p>\n Normalmente deve-se mover o eletrodo mais medialmente de encontro ao processo articular superior para corrigir o pocionamento. Uma vez que o eletrodo esteja em uma posi\u00e7\u00e3o adequada, 0,75 ml de lidoca\u00edna a 2% \u00e9 injetada atrav\u00e9s da c\u00e2nula para anestesiar o trajeto do nervo e os tecidos adjacentes. Ap\u00f3s o bloqueio anest\u00e9sico a c\u00e2nula \u00e9 recuada para expor o ponta do eletrodo que ent\u00e3o \u00e9 verificada nas incid\u00eancias AP, P e obliqua. A<\/p>\n les\u00e3o nervosa ent\u00e3o \u00e9 efetuada atrav\u00e9s do eletrodo que atinge uma temperatura de 85\u00baC, por 90 segundos, seguido de uma segunda les\u00e3o que \u00e9 feita atrav\u00e9s da exposi\u00e7\u00e3o de mais 5mm da ponta do eletrodo, chegando a um total de 8 a 10 mm.<\/p>\n O mesmo procedimento \u00e9 repetido em quantos n\u00edveis forem necess\u00e1rios de acordo com o caso.<\/p>\n CUIDADOS P\u00d3S-OPERAT\u00d3RIOS<\/strong><\/p>\n Profilaxia com antibi\u00f3tico \u00e9 feita com cefalosporina de 2 gera\u00e7\u00e3o 30 minutos antes do procedimento, na indu\u00e7\u00e3o anest\u00e9sica.<\/p>\n Sendo um procedimento percut\u00e2neo n\u00e3o utilizamos dreno e o paciente \u00e9<\/p>\n liberado no p\u00f3s operat\u00f3rio imediato assim que autorizado pelo anestesista, sem restri\u00e7\u00f5es quando a mobiliza\u00e7\u00e3o, n\u00e3o necessitando de repouso mesmo em casa.<\/p>\n O paciente \u00e9 acompanhado no ambulat\u00f3rio nas semanas seguintes para<\/p>\n avalia\u00e7\u00e3o de dor.<\/p>\n COMPLICA\u00c7\u00d5ES<\/strong><\/p>\n \u2022 Dor decorrente de les\u00e3o t\u00e9rmica do ramo cut\u00e2neo dorsal de L3<\/p>\n \u2022 Les\u00e3o nos ramos ventrais de L3 ou L4<\/p>\n \u2022 Infec\u00e7\u00e3o<\/p>\n RECOMENDA\u00c7\u00d5ES<\/strong><\/p>\n \u2022 Sele\u00e7\u00e3o criteriosa do paciente atrav\u00e9s de aspectos cl\u00ednicos e Resson\u00e2ncia\u00a0Magn\u00e9tica<\/p>\n \u2022 Conhecimento profundo da anatomia, da t\u00e9cnica e do instrumental<\/p>\n \u2022 Utiliza\u00e7\u00e3o de intensificador de imagem de boa qualidade<\/p>\n REFER\u00caNCIAS BIBLIOGR\u00c1FICAS<\/strong><\/p>\n 1. Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: evidence based practice guidelines in the management of chronic spinal pain. Pain Physician. 2007;10:7\u2013112.<\/p>\n 2. Elliott AM, Smith BH, Hannaford PC, et al. The course of chronic pain in the community: results of a 4-year follow-up study. Pain. 2002;99:299\u2013307.<\/p>\n 3. Volinn E. The epidemiology of low back pain in the rest of the world. Spine. 1997;22:1798.<\/p>\n 4. Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord. 2000;13:205\u2013217.<\/p>\n 5. Andreula C, Muto M, Leonardi M. Interventional spinal procedures. Eur J Radiol. 2004;50:112\u2013119.<\/p>\n 6. Oksuz E. Prevalence, risk factors, and preference-based health states of low back pain in a Turkish population. Spine. 2006;31:968\u2013972.<\/p>\n 7. Cassidy JD, Cote P, Carroll LJ, et al. Incidence and course of low back pain episodes in the general population. Spine. 2005;30:2817\u20132823.<\/p>\n 8. Thomas E, Silman AJ, Croft PR, et al. Predicting who develops chronic low back pain in primary care. A prospective study. Br Med J. 1999;318:1662\u20131667.<\/p>\n 9. Manchikanti L, Manchikanti KN, Manchukonda R, et al. Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Pain Physician. 2007; 10:425\u2013440.<\/p>\n 10. Schwarzer AC, Aprill CN, Derby R, et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine. 1994;19: 1132\u20131137.<\/p>\n 11. Manchikanti L, Pampati VS, Fellows B, et al. Prevalence of lumbar facet joint pain in chronic low back pain. Pain Physician. 1999; 2:59\u201364.<\/p>\n 12. Manchikanti L, Cash KA, Pampati V, et al. Influence of psychological variables on the diagnosis of facet joint involvement in chronic spinal pain. Pain Physician. 2008;11:145\u2013 160.<\/p>\n 13. Schwarzer AC, Aprill CN, Derby R, et al. The relative contributions of the disc and zygapophyseal joint in chronic low back pain. Spine. 1994;19:801\u2013806.<\/p>\n 14. Adams MA, Hutton WC. The mechanical function of the lumbar apophyseal joints. Spine. 1983;8:327\u2013330.<\/p>\n 15. Goldthwait JE. The lumbrosacral articulation: an explanation of many cases of \u2018\u2018lumbago\u2019\u2019, \u2018\u2018sciatica\u2019\u2019 and paraplegia. Boston Med Surg J. 1911;64:367\u2013372.<\/p>\n 16. Putti V. New conceptions in the pathogenesis of sciatic pain. Lancet. 1927;2:53\u201360.<\/p>\n 17. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106: 591\u2013614.<\/p>\n 18. Cavanaugh JM, Ozaktay AC, Yamashita HT, et al. Lumbar facet pain: biomechanics, neuroanatomy and neurophysiology. J Bio- mech. 1996;29:1117\u20131129.<\/p>\n 19. Dory MA. Arthrography of the lumbar facet joints. Radiology. 1981;140:23\u201327.<\/p>\n 20. Maldague B, Mathurin P, Malghem J. Facet joint arthrography in lumbar spondylosis. Radiology. 1981;140:29\u201336.<\/p>\n 21. Ashton IK, Ashton BA, Gibson SJ, et al. Morphological basis for back pain. The demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in the ligamentum flavum. J Orthop Res. 1992;10:72\u201378.<\/p>\n 22. Hogan QH, Abram SE. Diagnostic and prognostic neural blockade. In: Cousins MJ, ed. Neural Blockade in Clinical Anesthesia and Management of Pain, 3rd ed. Philadelphia: Lippincott-PhilRaven; 1998: 837\u2013877.<\/p>\n 23. Dreyfuss P, Halbrook B, Pauza K, et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine. 2000;25:1270\u20131277.<\/p>\n 24. Gofeld M, Jitendra J, Faclier G. Radiofrequency denervation of the lumbar zygapophysial Joints: 10-year prospective clinical audit. Pain Physician. 2007;10:291\u2013299.<\/p>\n 25. Rees WS. Rhysolysis of the nerves of the zygoapophyseal joints. Spine. 1983;8:118\u2013120.<\/p>\n 26. Barlocher CB, Krauss JK, Seiler RW. Kryorhizotomy: an alter- native technique for lumbar medial branch rhizotomy in lumbar facet syndrome. J Neurosurg. 2003;98:14\u201320.<\/p>\n 27. Staender M, Maerz U, Tonn JC, et al. Computerized tomography- guided kryorhizotomy in 76 patients with lumbar facet joint syndrome. J Neurosurg Spine. 2005;3:444\u2013449.<\/p>\n 28. Carette S, Marcoux S, Truchon R, et al. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Eng J Med. 1991;325:1002\u20131007.<\/p>\n 29. Tuite MJ. Facet joint and sacroiliac joint injection. Semin Roentgenol. 2004;39:37\u201351.<\/p>\n 30. Schulte TL, Pietila TA, Heidenreich J, et al. Injection theraphy of lumbar facet syndrome: a prospective study. Acta Neurochir (Wien). 2006;148:1165\u2013117<\/p>\n","protected":false},"excerpt":{"rendered":" Carlos Eduardo Gon\u00e7ales Barsotti,Thiago Miller Santana Silva,\u00a0Bartholomeu Ribeiro Coutinho Filho, Francisco Prado, Jefferson Alves\u00a0Galves, Carlos Eduardo Algaves Soares de Oliveira RESUMO Os autores apresentam t\u00e9cnica minimamente invasiva para o tratamento da dor\u00a0lombar cr\u00f4nica, relacionada \u00e0 s\u00edndrome facet\u00e1ria atrav\u00e9s do uso da denerva\u00e7\u00e3o facet\u00e1ria\u00a0com radiofrequ\u00eancia Palavras-chave:\u00a0Dor lombar baixa, radiofreq\u00fc\u00eancia percut\u00e2nea, s\u00edndrome facet\u00e1ria, redu\u00e7\u00e3o da dor. INTRODU\u00c7\u00c3O […]<\/p>\n","protected":false},"author":1,"featured_media":1277,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[51,52],"class_list":["post-292","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-coluna","tag-radiofrequencia","tag-sindrome-facetaria","cat-2-id","has_thumb"],"yoast_head":"\n![\"\"](\"http:\/\/www.ortopediadacoluna.com.br\/wp-content\/uploads\/2012\/11\/radiofrequencia1.jpg\" "\\"radiofrequencia1\\"")
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![\n<\/a><\/p>\nNormalmente deve-se mover o eletrodo mais medialmente de encontro ao processo articular superior para corrigir o pocionamento. Uma vez que o eletrodo esteja em uma posi\u00e7\u00e3o adequada, 0,75 ml de lidoca\u00edna a 2% \u00e9 injetada atrav\u00e9s da c\u00e2nula para anestesiar o trajeto do nervo e os tecidos adjacentes. Ap\u00f3s o bloqueio anest\u00e9sico a c\u00e2nula \u00e9 recuada para expor o ponta do eletrodo que ent\u00e3o \u00e9 verificada nas incid\u00eancias AP, P e obliqua. A<\/p>\nles\u00e3o nervosa ent\u00e3o \u00e9 efetuada atrav\u00e9s do eletrodo que atinge uma temperatura de 85\u00baC, por 90 segundos, seguido de uma segunda les\u00e3o que \u00e9 feita atrav\u00e9s da exposi\u00e7\u00e3o de mais 5mm da ponta do eletrodo, chegando a um total de 8 a 10 mm.<\/p>\nO mesmo procedimento \u00e9 repetido em quantos n\u00edveis forem necess\u00e1rios de acordo com o caso.<\/p>\nCUIDADOS P\u00d3S-OPERAT\u00d3RIOS<\/strong><\/p>\nProfilaxia com antibi\u00f3tico \u00e9 feita com cefalosporina de 2 gera\u00e7\u00e3o 30 minutos antes do procedimento, na indu\u00e7\u00e3o anest\u00e9sica.<\/p>\nSendo um procedimento percut\u00e2neo n\u00e3o utilizamos dreno e o paciente \u00e9<\/p>\nliberado no p\u00f3s operat\u00f3rio imediato assim que autorizado pelo anestesista, sem restri\u00e7\u00f5es quando a mobiliza\u00e7\u00e3o, n\u00e3o necessitando de repouso mesmo em casa.<\/p>\nO paciente \u00e9 acompanhado no ambulat\u00f3rio nas semanas seguintes para<\/p>\navalia\u00e7\u00e3o de dor.<\/p>\nCOMPLICA\u00c7\u00d5ES<\/strong><\/p>\n\u2022 Dor decorrente de les\u00e3o t\u00e9rmica do ramo cut\u00e2neo dorsal de L3<\/p>\n\u2022 Les\u00e3o nos ramos ventrais de L3 ou L4<\/p>\n\u2022 Infec\u00e7\u00e3o<\/p>\nRECOMENDA\u00c7\u00d5ES<\/strong><\/p>\n\u2022 Sele\u00e7\u00e3o criteriosa do paciente atrav\u00e9s de aspectos cl\u00ednicos e Resson\u00e2ncia\u00a0Magn\u00e9tica<\/p>\n\u2022 Conhecimento profundo da anatomia, da t\u00e9cnica e do instrumental<\/p>\n\u2022 Utiliza\u00e7\u00e3o de intensificador de imagem de boa qualidade<\/p>\nREFER\u00caNCIAS BIBLIOGR\u00c1FICAS<\/strong><\/p>\n1. Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: evidence based practice guidelines in the management of chronic spinal pain. Pain Physician. 2007;10:7\u2013112.<\/p>\n2. Elliott AM, Smith BH, Hannaford PC, et al. The course of chronic pain in the community: results of a 4-year follow-up study. Pain. 2002;99:299\u2013307.<\/p>\n3. Volinn E. The epidemiology of low back pain in the rest of the world. Spine. 1997;22:1798.<\/p>\n4. Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord. 2000;13:205\u2013217.<\/p>\n5. Andreula C, Muto M, Leonardi M. Interventional spinal procedures. Eur J Radiol. 2004;50:112\u2013119.<\/p>\n6. Oksuz E. Prevalence, risk factors, and preference-based health states of low back pain in a Turkish population. Spine. 2006;31:968\u2013972.<\/p>\n7. Cassidy JD, Cote P, Carroll LJ, et al. Incidence and course of low back pain episodes in the general population. Spine. 2005;30:2817\u20132823.<\/p>\n8. Thomas E, Silman AJ, Croft PR, et al. Predicting who develops chronic low back pain in primary care. A prospective study. Br Med J. 1999;318:1662\u20131667.<\/p>\n9. Manchikanti L, Manchikanti KN, Manchukonda R, et al. Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Pain Physician. 2007; 10:425\u2013440.<\/p>\n10. Schwarzer AC, Aprill CN, Derby R, et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine. 1994;19: 1132\u20131137.<\/p>\n11. Manchikanti L, Pampati VS, Fellows B, et al. Prevalence of lumbar facet joint pain in chronic low back pain. Pain Physician. 1999; 2:59\u201364.<\/p>\n12. Manchikanti L, Cash KA, Pampati V, et al. Influence of psychological variables on the diagnosis of facet joint involvement in chronic spinal pain. Pain Physician. 2008;11:145\u2013 160.<\/p>\n13. Schwarzer AC, Aprill CN, Derby R, et al. The relative contributions of the disc and zygapophyseal joint in chronic low back pain. Spine. 1994;19:801\u2013806.<\/p>\n14. Adams MA, Hutton WC. The mechanical function of the lumbar apophyseal joints. Spine. 1983;8:327\u2013330.<\/p>\n15. Goldthwait JE. The lumbrosacral articulation: an explanation of many cases of \u2018\u2018lumbago\u2019\u2019, \u2018\u2018sciatica\u2019\u2019 and paraplegia. Boston Med Surg J. 1911;64:367\u2013372.<\/p>\n16. Putti V. New conceptions in the pathogenesis of sciatic pain. Lancet. 1927;2:53\u201360.<\/p>\n17. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106: 591\u2013614.<\/p>\n18. Cavanaugh JM, Ozaktay AC, Yamashita HT, et al. Lumbar facet pain: biomechanics, neuroanatomy and neurophysiology. J Bio- mech. 1996;29:1117\u20131129.<\/p>\n19. Dory MA. Arthrography of the lumbar facet joints. Radiology. 1981;140:23\u201327.<\/p>\n20. Maldague B, Mathurin P, Malghem J. Facet joint arthrography in lumbar spondylosis. Radiology. 1981;140:29\u201336.<\/p>\n21. Ashton IK, Ashton BA, Gibson SJ, et al. Morphological basis for back pain. The demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in the ligamentum flavum. J Orthop Res. 1992;10:72\u201378.<\/p>\n22. Hogan QH, Abram SE. Diagnostic and prognostic neural blockade. In: Cousins MJ, ed. Neural Blockade in Clinical Anesthesia and Management of Pain, 3rd ed. Philadelphia: Lippincott-PhilRaven; 1998: 837\u2013877.<\/p>\n23. Dreyfuss P, Halbrook B, Pauza K, et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine. 2000;25:1270\u20131277.<\/p>\n24. Gofeld M, Jitendra J, Faclier G. Radiofrequency denervation of the lumbar zygapophysial Joints: 10-year prospective clinical audit. Pain Physician. 2007;10:291\u2013299.<\/p>\n25. Rees WS. Rhysolysis of the nerves of the zygoapophyseal joints. Spine. 1983;8:118\u2013120.<\/p>\n26. Barlocher CB, Krauss JK, Seiler RW. Kryorhizotomy: an alter- native technique for lumbar medial branch rhizotomy in lumbar facet syndrome. J Neurosurg. 2003;98:14\u201320.<\/p>\n27. Staender M, Maerz U, Tonn JC, et al. Computerized tomography- guided kryorhizotomy in 76 patients with lumbar facet joint syndrome. J Neurosurg Spine. 2005;3:444\u2013449.<\/p>\n28. Carette S, Marcoux S, Truchon R, et al. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Eng J Med. 1991;325:1002\u20131007.<\/p>\n29. Tuite MJ. Facet joint and sacroiliac joint injection. Semin Roentgenol. 2004;39:37\u201351.<\/p>\n30. Schulte TL, Pietila TA, Heidenreich J, et al. Injection theraphy of lumbar facet syndrome: a prospective study. Acta Neurochir (Wien). 2006;148:1165\u2013117<\/p>\n","protected":false},"excerpt":{"rendered":"Carlos Eduardo Gon\u00e7ales Barsotti,Thiago Miller Santana Silva,\u00a0Bartholomeu Ribeiro Coutinho Filho, Francisco Prado, Jefferson Alves\u00a0Galves, Carlos Eduardo Algaves Soares de Oliveira RESUMO Os autores apresentam t\u00e9cnica minimamente invasiva para o tratamento da dor\u00a0lombar cr\u00f4nica, relacionada \u00e0 s\u00edndrome facet\u00e1ria atrav\u00e9s do uso da denerva\u00e7\u00e3o facet\u00e1ria\u00a0com radiofrequ\u00eancia Palavras-chave:\u00a0Dor lombar baixa, radiofreq\u00fc\u00eancia percut\u00e2nea, s\u00edndrome facet\u00e1ria, redu\u00e7\u00e3o da dor. 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