RT Book, Section A1 Paterno, Josemaria A1 Rathmell, James P. A1 Gilligan, Chris A2 Bajwa, Zahid H. A2 Wootton, R. Joshua A2 Warfield, Carol A. SR Print(0) ID 1131938823 T1 Cryoanalgesia and Radiofrequency Ablation T2 Principles and Practice of Pain Medicine, 3e YR 2016 FD 2016 PB McGraw-Hill Education PP New York, NY SN 9780071766838 LK neurology.mhmedical.com/content.aspx?aid=1131938823 RD 2024/10/12 AB Radiofrequency ablation (RFA) has an established and expanding role in the treatment of a myriad of pain conditions. As early as the 1930s, the application of electric current for neural ablation was reported in the medical literature. Clinicians initially used large (12–14 gauge) electrodes emitting direct current, which risked mechanical injury and produced unpredictable lesions.1 However, investigators soon discovered that alternating current in the radiofrequency (RF) range between 300 and 500 KHz created more predictable lesions.2,3 In the early 1950s, the first commercial RF lesion generator became available through the collaboration between electrical engineer Bernard Cosman and neurosurgeon Thomas Sweet at the Massachusetts General Hospital. In 1975, RFA was first described in the literature for the treatment of back pain.1,4 Over the subsequent decades, RFA has become a widespread and effective treatment to create significant and sustained pain relief. Current and expanding clinical applications of RFA include facial; cervical, thoracic, and lumbar facet; spinal radicular; sacroiliac joint (SIJ); lumbar discogenic; peripheral nerve; intraarticular joint; and sympathetically mediated pain. The bulk of clinical data involves conventional RFA; however, over the past decade, modified forms of RF treatments have emerged. Today four forms of RFA predominate in clinical use: conventional (i.e. continuous) RFA (CRF), pulsed RFA (PRF), water-cooled RFA (WCRF), and bipolar RFA (BRF) (Fig. 91-1):