Radiofrequency (RF) lesions have been used for over 25 years in the treatment of intractable pain of spinal origin. The conventional understanding of this technique is that the heat which is produced in the tissue surrounding the electrode tip causes destruction of nervous tissue, which in turn reduces the input of noxious nerve stimuli and alleviates pain. Neuropathic pain is usually a contra-indication to the use of RF nerve lesioning. For treatment of patients with severe radicular pain we use pulsed radiofrequency who has been recently described as a technique to apply a relatively high voltage near a nerve but without the usual effects of rise in temperature or subsequent nerve injury.

This study reports the effect of pulsed RF in 21 patients with severe radicular pain who had previously failed to respond to conventional therapy.

Patients and Methods: From December 2000 to August 2001, 18 patients underwent pulsed RF Rhizotomy of Dorsal Root Ganglion (DRG) of segmental N. Root of the painful dermatome. Out of them, 16 passed treatment in the lumbar area and 2 in the neck. The age of the patients ranged from 20 to 75 years (m=55.7 years). Male/female ratio was 1.4/1. 50% was previously operated (discectomy, laminectomy). No complications were seen either in the procedure or in the follow-up.

Results: Out of 21 patients, 3 (14.3%) did not respond to treatment. In the remaining 18 patients Rhizotomy was successful at 3 months follow-up. Mean VAS score before procedures was 8.85 (range 7–10), after treatment 3.8 (range 0–10).

Conclusion: Pulsed RF treatment is a safe, simple procedure to control radicular, neuropathic pain in the cervical, thoracic and lumbar regions. Advantages of this method:

It is non-destructive procedure and it can therefore be used for different indication which were not suitable for conventional RF.

Objective: To assess the safety and outcome of laminectomy in patients with spinal stenosis operated at the age of 65 years or older. The relation between the duration of the symptoms and results was investigated.

Study Design: A retrospective chart analysis with up to 10 years follow-up.

Setting: The Spinal Care Unit, Meir Medical Center, Kfar Saba, Israel.

Material and Methods: The medical records of all patients who had laminectomy for spinal stenosis at the age of 65 or more in a 10 years period were reviewed. Assessment of pain, ability to perform the basic activities of daily living, transferring dressing and basing before and after the operation was done by a telephone interview. Patient’s self-estimation of the final result of the surgery was also recorded.

Results: Two hundred eight-three patients were eligible to participate in the study.

They were allocated into 3 groups according to the duration of symptoms before surgery. Group A with symptoms lasting up to 24 months, B with 25–48 months and C with symptoms lasting for more than 48 months. The average age at the time of the operation was 68.9, 72.6 and 71.3 years, respectively. Forty-eight patients died and 18 refused or were not able to participate in the study. The average time of follow-up was 43.3 months, 42.2 in group A, 47.4 in B and 42.8 in C.

No significant differences were noticed in the demographic, anesthetic and surgical parameters among the 3 groups.

There were no mortality cases in the immediate postoperative period. The overall complication rate was 43.5%, nearly identical in all 3 groups. Two patients had cerebrovascular accident and 5 had myocardial ischemia but no one turned into infarction. Mild complications included 11 urinary retention, 24 urinary tract infections and 11 patients with superficial wound infection. Twenty-two patients were re-operated along the follow-up period.

There was remarkable improvement in the perception of pain, walking distances and in the ability to perform basic activities of daily living in all 3 groups. Self-assessment of the final results disclosed 70% satisfied patients in group A, 67% in B and 67% in C.

Conclusion: Surgery for spinal stenosis in elderly patients is safe and often lead to significant relief of pain and improvement in the quality of life. Delaying surgery had no deleterious effect on the operative results.

Study Design: We describe innovative minimally invasive Israeli made Expandable Spinal Fusion System for lumbar spinal fusion, in patients with all caused of mechanical back pain: Degenerative Disc Disease (DDD) at one or two levels from L2–S1, up to Grade l spondylolysthesis. The purpose of the study was to provide a preliminary evaluation of the safety and efficacy of the Expandable Spinal Fusion System in establishing vertebral stability and fusion, and in improving the quality of life of the patients.

The relatively large diameter of currently used cages dictates extensive manipulations, damaging structures that are crucial for spinal stability.

The Expandable Spinal Fusion System, is 5 mm in diameter in closed configuration, applied in a minimally invasive technique, through a 6mm entering opening by an open or percutaneous posterior procedures. Once in position, its dimensions are increased to a precut size in a controlled procedure. Thus, this system maintains the integrity of facet joints, with no or minimal laminectomy, and minimal damage to the surrounding tissues.

Methods: Data were collected in a series of 60 patients with DDD in levels L3–S1. The patients wee operated in the open posterior approach with or without Pedicle Screws and percutaneous posterolateral. Both end-plates faces were treated by special curettes and partially removed. Posterior iliac bone graft was used and 2 tubes device were introduced to the inter-somatic space under direct vision controlled by X-rays C-Arm intensifying magnification.

Data: The implantation approach was posterior in 52 patients, anterior in 2 and percutaneous in 6 patients. Maximal follow up period is 12 months. Patients follow up was completed according to investigational protocol mandate follow up visit at 1.5, 3, 6, 12 months postoperatively. The main at the time of the surgery was 52 years old. 57 underwent surgery at one level as follows: 3 at L3-L4, 32 at L4-L5, and 21 at L5-S1, and 3 underwent surgery at two levels.

Patient questionnaire pain and quality of life was evaluated using the Oswestry questionnaire and VAS measurement. The patient fill those pre-operatively and at each follow up visit.

Results: Although follow up period is short according to preliminary data, the Expandable Spinal Fusion System has proved to be safe, effective, as well as easy to handle for treating all cases of mechanical back pain: DDD. There was no neurological injury, no infection, no death and no worsening of clinical symptoms. There was no breakage or migration of the implant at the last follow-up. Flexion-Extension X-ray show good stability. VAS score for pain dropped from 8 pre op to 2.6 in average 3 months post-op.