Radiofrequency (RF) Generators, Electrodes, and Cannulas for Pain Management and Neurosurgery - Cosman Medical

Management of Intractable Pain from Foot and Ankle Disorders

Radiofrequency (RF) nerve ablation is a percutaneous, reimbursable, office-based technique that has been used for decades to treat intractable pain arising disorders of the foot and ankle, including plantar fasciitis and Morton's Neuroma.^{1, 2, 3, 4}  One retrospective study reports that radiofrequency lesioning relieved plantar fascial pain in 92% of 39 patients for whom conservative treatment failed.²  Cosman Medical draws on 60 years of pioneering experience in radiofrequency medicine to provide a full range of radiofrequency equipment specialized for podiatric practices.

Radiofrequency disrupts painful impulses by heating nerve with high-intensity electric currents.  An RF procedure generally includes the following steps:^1,2,3,4

1. Place the Ground Pad on the ipsilateral calf.
2. Place the RF cannula percutaneously.
3. Stimulate: Verify that is cannula is near the target nerve and distant from non-target nerves using sensory and motor nerve stimulation.
4. Inject: Anesthetize the nerve to prevent pain during heating.
5. Lesion: Ablate the nerve by electrifying the RF cannula with automatic temperature control.

The New Cosman Unified (CU) Electrode Simplifies Treatment

Cosman has refined the equipment used for podiatry pain management since Prof. Eric Cosman, Sr, PhD created the Radionics® RFG-3B and RFG-3C, RF generators used in early approaches to RF treatment of intractable pain from Morton's Neuroma¹ and plantar fasciitis^2,3.  In the classical technique, the RF cannula is electrified using a separate RF electrode, and numerous manipulations were required to both inject anesthetic and lesion a nerve.  Today, the new Cosman CU^TM injection electrode (U.S. Patent 7,862,563) unifies a cannula, electrode, and flexible injection port into a single tissue-piercing, temperature-measuring device.  Since the CU electrode does not need to be manipulated through stimulation, injection, and lesioning, you can ensure the electrode doesn't shift from its intended position.  Cosman offers equipment for both the classic and unified techniques.

	Cosman Classic Kit	Cosman Unified Kit (CU)
RF Equipment	RF Generator Ground Pad RF Cannula RF Electrode	RF Generator Ground Pad CU RF Electrode/Cannula
Procedure	Place the Ground Pad on the calf Place the RF cannula Remove the cannula's stylet and replace with the RF electrode Stimulate Remove the electrode to allow injection Inject directly into the cannula's hub Place the RF electrode in the cannula Lesion	Place the Ground Pad on the calf Place the CU RF electrode Stimulate Inject through the flexible tubing Lesion

RF Equipment

Cosman offers a complete set of equipment for both the classical and the unified treatment techniques.  Compare the cost, quality, and simplicity of Cosman Podiatry products to Neurotherm® Podiatry products.

Radiofrequency Generator (RFG-1B)

The RFG-1B radiofrequency generator has simplified controls that are ideally suited for podiatry and the treatment of intractable pain from plantar fasciitis and Morton's Neuroma.  The RFG-1B automatically controls the temperature of radiofrequency heat lesions to block pain signals in nerves, such as the inferior calcaneal nerve⁵.  Its integrated stimulator produces a 50 Hz signal to localize the sensory fibers innervating a painful area, and a 2 Hz signal to ensure that nearby motor fibers are spared.  The RFG-1B generator is versatile and very easy to use.

Compare the functionality, display clarity, and ease of use of the Cosman RFG-1B radiofrequency generator with that of the Neurotherm® NT250 radiofrequency generator.

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Unified RF Electrode/Cannula (CU 060523)

The ultimate in functionality, precision, and control, the CU is a disposable, tissue-piercing RF cannula/electrode with a long fluid injection line and thermocouple (TC) temperature sensor.  Each electrode comes sterile-packed to eliminate sterilization planning, and has sharp, beveled tip to eliminate the need for an introducer cannula.  Its position is maintained through stimulation, injection, and lesioning due to its flexible injection line.  The CU electrode has a discrete, ergonomic hub for clear fluoroscopic views and easy handling.  The 5 mm active tip size and slender shaft are well suited to create discrete lesions in painful nerves.

The CU's design is unique and protected by U.S. Patent 7,862,563.

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RF Cannula (CC 5422)

A smooth, steerable, cost-effective RF Cannula for use with an RF Electrode (TCD-5 or CSK-TC5).  The insulation is specially tapered at the tip for easy insertion and maneuvering.  The 4 mm active tip size and slender shaft are well suited to create discrete lesions in painful nerves.  Each cannula comes sterile-packed and is for single use only.

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RF Electrode (TCD-5 or CSK-TC5)

An RF Electrode is used with an RF Cannula (CC 5422) to deliver RF and measure the heat lesion temperature.  Two versions of the electrode are available:

• Disposable (TCD-5): Each single-use electrode comes sterile-packed to eliminate sterilization logistics, the need for an autoclave, and the possibility of disease transmission.
• Autoclavable (CSK-TC5): Each electrode is designed for reuse in multiple procedures.

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Ground Pad (DGP-PM)

The DGP-PM ground pad is disposable and designed for use with the Cosman RF generators.  Each ground pad is individually packed and comes with an integral cable for connection to the RF generator.  For single-use only.

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External Links

1. An online lecture on Present Podiatry by Dominic Catanese, DPM, FACFAS on Radiofrequency treatment of Inferior Calcaneal Heel Pain and Neuromas

References

1. Finney W, Wiener SN, Catazariti F. Treatment of Morton’s Neuroma Using Percutaneous Electrocoagulation. Journal of the American Podiatric Medical Association 1989; 79(12): 615-618.  [PDF]
2. Sollitto RJ, Plotkin EL, Klein PG, Mullin P. Early Clinical Results of the Use of Radiofrequency Lesioning in the Treatment of Plantar Fasciitis. The Journal of Foot & Ankle Surgery 1997; 36(3): 215-219.  [PDF]
3. Cione JA, Cozzarelli J, Mullin CJ. A Retrospective Study of Radiofrequency Thermal Lesioning for the Treatment of Neuritis of the Medial Calcaneal Nerve and its Terminal Branches in Chronic Heel Pain. The Journal of Foot & Ankle Surgery 2009; 48(2): 142–147.  [PDF]
4. Liden B, Simmons M, Landsman AS. A Retrospective Analysis of 22 Patients Treated with Percutaneous Radiofrequency Nerve Ablation for Prolonged Moderate to Severe Heel Pain Associated with Plantar Fasciitis. The Journal of Foot & Ankle Surgery 2009; 48(6): 642-647.
5. Louisia S, Masquelet AC. The medial and inferior calcaneal nerves: an anatomic study. Surgical and Radiologic Anatomy 1999; 21: 169-173.  [PDF]

* NeuroTherm, NT1000, NT1100, NT2000, NT500, NT250 are trademarks or registered trademarks of NeuroTherm, Inc.
* Cotop, CXE, CX, RCN, SMK, CdisK are trademarks or registered trademarks of Cotop International B.V. or NeuroTherm, Inc.
* Radionics, CRW, BRW are trademarks or registered trademarks of Integra Radionics, Inc.
* RFG-3C, RFG-3C plus, Disctrode, Valleylab are trademarks or registered trademarks of Covidien AG.