Image Guided Facet Joint Corticosteroid Injection
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Surgery is considered as the curative treatment for most malignant and benign tumours. However, several factors, including patient comorbidity or the anatomy of the lesion, may preclude surgery in some patients. Radiofrequency ablation is one of a number of locoregional therapies that can be used to treat such patients.
Radiofrequency ablation uses a high-frequency alternating current via a needle electrode placed within the tissue to induce temperature changes and consequent coagulative necrosis and tissue desiccation.
Although laparoscopic and open approaches can be used, radiofrequency ablation is usually achieved by an interventional radiologist using a percutaneous approach with either ultrasound or CT scanning guidance. Local or general anaesthesia can be used. The percutaneous approach generally permits the procedure to be carried out as a same day or overnight stay procedure.
The size and location of the lesion is critical for the success of radiofrequency ablation. Therefore, the decision to use radiofrequency ablation is generally best made after multidisciplinary consultation between surgeons, oncologists and interventional radiologists.
CT scan of the affected region is the commonest preliminary imaging test. Ultrasound, MRI and PET scans may also be required.
Haematology testing including haemoglobin, platelet count, prothrombin time, INR and partial prothrombin time should be carried out, as should liver and renal function tests if the procedure is to be carried out under general anaesthesia or the target organ is the liver or kidney.
Bleeding is the major risk in this procedure. Therefore, anticoagulation (heparin, warfarin, clexane, aspirin, anti-platelets) should be stopped, depending on the patient’s circumstances.
History of allergy to any medication and previous cardiac pacemaker insertion is also important. If a pacemaker is in place, the radiologist should be advised and a cardiologist should be consulted before the procedure.
Coagulopathy with INR > 1.5 and platelet counts < 50,000 per mm³ are absolute contraindications.
NOTE: treatment with aspirin is not a contraindication to radiofrequency ablation.
Surgery is the first-line treatment for cancer. Radiofrequency ablation is one of the alternative treatments. Other alternative treatments include chemotherapy, transarterial chemoembolisation, microwave ablation, laser ablation and cryoablation. The decision of which treatment to use relies on tumour type, patient comorbidity, physician and site experience, and availability of treatment options.
The American College of Radiology together with the Radiological Society of North America has developed consumer information about radiofrequency ablation:
Page last modified on 30/8/2018.
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RANZCR® intends by this statement to exclude liability for any such opinions, advices or information. The content of this publication is not intended as a substitute for medical advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor. Some of the tests and procedures included in this publication may not be available at all radiology providers.
RANZCR® recommends that any specific questions regarding any procedure be discussed with a person's family doctor or medical specialist. Whilst every effort is made to ensure the accuracy of the information contained in this publication, RANZCR®, its Board, officers and employees assume no responsibility for its content, use, or interpretation. Each person should rely on their own inquires before making decisions that touch their own interests.