MIPSI or Minimally invasive pain and spine interventions is a broad term which encompasses all the Non-invasive and minimally invasive interventions done by the interventional spine and pain physicians for myriad of conditions right from Musculo-skeletal disorders like back pain, neck pain, knee pain etc.
What is Ganglion Impar and where is it situated?
In our body, a chain of sympathetic ganglia is present bilaterally on either side of the vertebrae which extend from upper neck down to the coccyx. There are usually 22-23 pairs of these ganglia: 3 in the cervical region, 11 in the thoracic region, 4 in the lumbar region and 4-5 in the sacral region.
Ganglion impar also known as the Sacrococcygeal ganglion or Ganglion of Walther is the termination of this paired sympathetic chain in the form the ganglion just anterior to the Sacrococcygeal junction.
What is the procedure of Ganglion Impar Radiofrequency neurectomy?
Ganglion Impar Radiofrequency neurectomy is an advanced procedure which involves the precise placement of the Radiofrequency needle just anterior to the Sacro-coccygeal junction, identification of the ganglion with the help of sensory and motor stimulation and then its targeted ablation using Radiofrequency current.
Whole procedure is done under local anaesthesia with some mild sedation.
What are the Indications of Ganglion Impar neurectomy?
- Chronic Perineal pain
- Cancer pain from Rectal, Prostatic or Cervical cancer
- Post-herpetic pain
- Sympathetically mediated perineal pain
How Ganglion Impar neurectomy MIPSI helps relief pain?
Ganglion Impar Radiofrequency neurectomy mainly acts by 2 mechanisms:
Peripheral Wallerian degeneration of the nerve: Due to the application of Radiofrequency currents , the friction between the various tissue molecules generate thermal energy which burns the nerves and brings about what is called as conduction block. So these nerves stop conducting pain signals from the affected site towards the brain where pain stimulus is actually processed and patient feels immediate relief from pain.
Central neuromodulation: Chronic pain has a component of Central Sensitization where in there is amplification of the pain signals in the brain and patients experience pain even in the absence of any movements or painful stimulus. With application of Radiofrequency ablation there is modulation in these central neural circuitries and the central sensitization is abolished.
How early the beneficial effects can be seen?
Patient can start appreciating the effect of the procedure within 3-4 days and maximal effect is achieved over a period of 3-4 weeks.
How many times this procedure has to be repeated?
The effect of this procedure can last from about 6 months to few years, after which this procedure has to be repeated. During this pain free period patient becomes drug free and thus escapes from the side effects of these medications which occur due to prolonged use of the drugs.
Will I require hospitalization for this procedure?
Yes. Patient generally is hospitalized for a period of 24 hours post-procedure for observation.
To see how this procedure is done, click the below link