• Anthony Dragovich and Robert J Trainer.
• Department of Pain Medicine, Beth Israel Deaconness Medical Center, Boston, MA, USA.
• Pain Med. 2011 Apr 1;12(4):679-81.

ObjectiveTo provide the advanced interventional procedure of zygapophysial joint neurotomy to soldiers meeting the diagnostic criteria in a combat environment and thus reduce medical evacuations of soldiers from a theater of war.DesignRetrospective chart review was performed on three consecutive soldiers who received neuroablation of the lumbar ZP joint. Patients received single MBB with 1 cc of 1% lidocaine at the b/l L3-L5 levels considered diagnostic if >50% analgesia was achieved concordant with duration of anesthetic.Setting  All procedures were co-performed by the two authors at the Ibn Sina hospital in Baghdad, Iraq over a 3-month period.PatientsThree consecutive patients with >50% pain relief from diagnostic medial branch blocks were treated with radiofrequency ablation of the bilateral L3-L4 medial branch nerves and L5 posterior primary ramus.InterventionsSensory test stimulation at 50 Hz and motor stimulation at 2 Hz were performed at each level. The nerves were then lesioned at 80° Centigrade for 90 seconds after injection of lidocaine and methylprednisolone.Outcome MeasuresProcedure was considered successful if patients were able to wear body armour without significant discomfort (at least 1 hour/day).Results And ConclusionsMedical evacuation from Iraq was prevented and all soldiers returned to rigorous combat duties including the wearing of body armour daily. We believe to be the first to report on the use of RF nerve ablation in a war time setting and with this functional outcome.Wiley Periodicals, Inc.

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