A Report of 3 Soldiers Returned to Full Duty after Lumbar Radiofrequency Facet Denervation in a Theater of War

Abstract

Objective. To provide the advanced interventional procedure of zygapophysial joint neurotomy to soldiers meeting the diagnostic criteria in a combat environment and thus reduce medical evacuations of soldiers from a theater of war. Design. Retrospective chart review was performed on three consecutive soldiers who received neuroablation of the lumbar ZP joint. Patients received single MBB with 1cc of 1% lidocaine at the b/l L3-L5 levels considered diagnostic if >50% analgesia was achieved concordant with duration of anesthetic. Setting. All procedures were co-performed by the two authors at the Ibn Sina hospital in Baghdad, Iraq over a 3-month period. Patients. Three consecutive patients with >50% pain relief from diagnostic medial branch blocks were treated with radiofrequency ablation of the bilateral L3-L4 medial branch nerves and L5 posterior primary ramus. Interventions. Sensory test stimulation at 50Hz and motor stimulation at 2Hz were performed at each level. The nerves were then lesioned at 80°Centigrade for 90 seconds after injection of lidocaine and methylprednisolone. Outcome Measures. Procedure was considered successful if patients were able to wear body armour without significant discomfort (at least 1 hour/day). Results and Conclusions. Medical evacuation from Iraq was prevented and all soldiers returned to rigorous combat duties including the wearing of body armour daily. We believe to be the first to report on the use of RF nerve ablation in a war time setting and with this functional outcome. © 2011 Wiley Periodicals, Inc.