Procedure Impar ganglion RF Treatment

Position and anatomical landmarks

The patient lies in the prone position on the operating table with a pillow under the pelvis, in such a way that the sacral bone is rotated in a ventral direction. Both cornu of the sacral hiatus are palpated. Thereafter, and more caudally, the sacro-coccygeal joint is marked and palpated.

Procedure

After sterile preparation of the area and by means of fluoroscopy, one needle is inserted trans-sacrococcygeally (through the sacrococcygeal ligament). A second needle is inserted through the coccygeal disc (Figure 1). In the lateral view, the positions of the needles are checked while contrast agent is being administered (Figure 2).

 

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Figure 1. RF treatment of the Impar ganglion; lateral view.

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Figure 2. RF treatment of the Impar ganglion; lateral view with contrast agent in place.

After stimulation at 50 Hz (up to 1 V) and 2 Hz (no motor reaction up to 3 V), each needle is heated up to 80°C for 80 seconds by means of RF.

Complications

  • The most serious complication after the injection is infection.
  • Small subcutaneous bleedings may result in a temporary increase in pain after the injection.
  • Local anaesthetic injection with corticosteroids always carries the risk of going through the disc and penetrating the rectum.