Article
Laser-guided lumbar medial branch kryorhizotomy – an improved minimally-invasive technique for the treatment of lumbar facet joint syndrome
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Published: | September 16, 2010 |
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Objective: Image-guided spinal interventions carry the potential of significant radiation exposure to both the patient and the surgeon. We describe a modification of the medial branch kryorhizotomy technique for the treatment of lumbar facet joint syndrome (LFJS), using a fluoroscopy-based laser-guided method, in order to reduce procedural time and radiation dose.
Methods: A total of 32 patients (19 males, 13 females, median age 53, range 29–71 years) suffering from LFJS confirmed by positive medial branch nerve block underwent conventional or laser-guided fluoroscopy-based kryorhizotomy (total of 78 denervation procedures consisting of 2 cryolesions each). A dose monitor chamber measured X-ray dose-area products. Pain severity was rated by the patients using the visual analogue scale (VAS) at the day before the intervention, during kryorhizotomy, 6 h thereafter, and after 6 months. Measuring the distance between the tip of the probe and the anatomical target point assessed accuracy of cryoablation probe positioning.
Results: Procedural time (20.6±1.0 and 16.3±0.9 min, respectively, p<0.01), fluoroscopy time (54.1±3.5 and 28.2±2.4 sec, respectively, p<0.01), radiation dose (407.5±32.0 and 224.1±20.3 cGy/cm2, respectively, p<0.01), and patient discomfort during the procedure (VAS 7.1±0.4 and 5.2±0.4, respectively, p<0.01) were significantly reduced in the laser-guided group. There was a tendency for a better positioning accuracy when the laser guidance method was used (3.0±0.3 and 2.2±0.3 mm deviation from the target points, respectively, p>0.05). No difference in the clinical outcome was observed between the two groups of patients (VAS 3.5±0.2 and 3.3±0.3, respectively, p>0.05).
Conclusions: Laser-guided medial branch kryorhizotomy is safe, feasible and results a significant reduction of radiation exposure and procedural discomfort when compared to the conventional fluoroscopy-based technique. Furthermore, we found a similar efficacy and a tendency towards a better positioning accuracy, when compared to the fluoroscopy-guided group. This improved minimally invasive surgical technique offers advantages to conventional fluoroscopy-based interventions.