Neuroablative Procedures Briefly Explained
Through targeted ablation, commonly referred to as “nerve cauterization,” pain signal transmission from a specific body region to the central nervous system (brain and spinal cord) can be interrupted long-term. This requires two positive diagnostic blocks, meaning preliminary test infiltrations with local anesthetics, as proof of the effectiveness of treating the nerves at that location. Additionally, only nerves that do not carry important motor functions should be ablated.
In short, large nerves responsible for sensation and movement should not be ablated. As a result, these procedures are not suitable for all areas of the body and are only used following careful, shared decision-making with the patient.
Nerve ablations (or cauterizations) are very similar in procedure to diagnostic nerve blocks, only slightly longer, and can all be safely performed on an outpatient basis in our practice. If desired, we also offer light sedation for relaxation. The procedure begins with precise localization of the nerves using ultrasound and/or X-ray, safety monitoring, and complete local anesthesia. Several technical options are available for nerve ablation:
- Ablation using targeted heat = Thermoablation. Thermal radiofrequency ablation is our standard method, for example, for chronic facet joint-related degenerative back pain.
- Ablation using targeted cold = Cryoablation. In some cases, this can be a gentler alternative to thermoablation, but it often does not result in complete nerve destruction and may be less long-lasting. We offer this treatment at our partner clinic in Zurich.
- Ablation using highly concentrated alcohol = Chemoneurolysis. By injecting 95% ethanol directly into the nerve area, a permanent blockade of nerve function can be achieved. This method is especially suited for fine nerve networks, such as around the knee or hip.
Chemoneurolysis at the knee and hip
The joint capsules of the knee and hip are supplied by many small nerve branches, including the genicular nerves and the pericapsular nerve group (PENG). At defined anatomical sites, these nerves can be accurately anesthetized under ultrasound guidance and, if necessary, permanently interrupted through chemoneurolysis. Muscle strength and function remain unaffected.
Since the treated joint may no longer cause pain but can still be irritated or degenerated, close coordination with orthopedic and physiotherapy specialists is essential to develop a comprehensive treatment plan. In general, this method is safe and effective both before and after any potentially necessary surgical procedures.
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