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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

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Laser-guided lumbar medial branch kryorhizotomy – an improved minimally-invasive technique for the treatment of lumbar facet joint syndrome

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  • Robert Andres - Universitätsklinik für Neurochirurgie, Universität Bern, Inselspital, Schweiz
  • Thilo Graupner - Universitätsklinik für Neurochirurgie, Universität Bern, Inselspital, Schweiz
  • Christian B. Bärlocher - Abteilung für Wirbelsäulenchirurgie, Klinik Stephanshorn, St. Gallen, Schweiz
  • Arthur Augsburger - Leuag AG, Stans, Schweiz
  • Javier Fandino - Neurochirurgische Klinik, Kantonsspital Aarau, Schweiz
  • Andreas Raabe - Universitätsklinik für Neurochirurgie, Universität Bern, Inselspital, Schweiz

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1810

doi: 10.3205/10dgnc281, urn:nbn:de:0183-10dgnc2814

Published: September 16, 2010

© 2010 Andres et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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.