Alternative denervation using laser irradiation in lumbar facet syndrome

Iwatsuki, Koichi; Yoshimine, Toshiki; Awazu, Kunio

doi:10.1002/lsm.20459

Cited by 19 publications

(7 citation statements)

References 29 publications

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“…In addition, similar pain reduction or relief (81% at 1-year follow-up) was observed in CLBP patients treated by laser irradiation of the FJ capsule. 16 A more recent study experimented with 3-dimensional navigation for endoscopic rhizotomy, yet it remains unclear whether this technique yields better outcomes. 17 …”

Section: Discussionmentioning

confidence: 99%

Endoscopic Sacrolumbar Facet Joint Denervation in Osteoarthritic and Degenerated Zygapophyseal Joints

Walter

Schildberg

Rommelspacher

2018

Arthroscopy Techniques

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Chronic low-back pain (CLBP) has an increasing incidence and yields a tremendous health economic burden. There are different anatomic structures that may be responsible for CLBP, such as lumbar intervertebral discs, sacroiliac joints, nerve root dura, fascia, ligaments, and muscles. However, to a large extent, CLBP is associated with structural changes in and around the facet (zygapophyseal) joint. If conservative treatment strategies fail, symptoms and pain can effectively be reduced by denervation or rhizotomy of the medial branch of the dorsal ramus of the spinal nerve through radiofrequency ablation. In this technical description with video, we present an endoscopic technique for radiofrequency rhizotomy. This technique has the advantage of directly visualizing the facet joint as well as its surrounding structures including the medial branches.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Sacrolumbar Facet Joint Denervation in Osteoarthritic and Degenerated Zygapophyseal Joints

Walter

Schildberg

Rommelspacher

2018

Arthroscopy Techniques

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“…Schaerer 13 reported good to excellent results in 50% of patients with cervical facet disease and 35% of patients with lumber disease after a mean follow-up of 13.7 months. Iwatsuki et al 5 reported significant pain relief in 71% of 21 patients at one year follow-up with laser denervation of the dorsal facet capsule. Li et al 8 treated 5 patients with RFA of the dorsal rami.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Facet Debridement for the treatment of facet arthritic pain - a novel new technique

Haufe¹,

Mork²

2010

Int. J. Med. Sci.

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Study design: Retrospective, observational, open label.Objective: We investigated the efficacy of facet debridement for the treatment of facet joint pain.Summary of background data: Facet joint disease, often due to degenerative arthritis, is common cause of chronic back pain. In patients that don't respond to conservative measures, nerve ablation may provide significant improvement. Due to the ability of peripheral nerves to regenerate, ablative techniques of the dorsal nerve roots often provide only temporary relief. In theory, ablation of the nerve end plates in the facet joint capsule should prevent reinnervation.Methods: All patients treated with endoscopic facet debridement at our clinic from 2003-2007 with at least 3 years follow-up were included in the analysis. Primary outcome measure was percent change in facet-related pain as measured by Visual Analog Scale (VAS) score at final follow-up visit.Results: A total of 174 people (77 women, 97 men; mean age 64, range 22-89) were included. Location of facet pain was cervical in 45, thoracic in 15, and lumbar in 114 patients. At final follow-up, 77%, 73%, and 68% of patients with cervical, thoracic, or lumbar disease, respectively, showed at least 50% improvement in pain. Mean operating time per joint was 17 minutes (range, 10-42). Mean blood loss was 40 ml (range, 10-100). Complications included suture failure in two patients, requiring reclosure of the incision. No infection or nerve damage beyond what was intended occurred.Conclusions: Our results demonstrate a comparable efficacy of endoscopic facet debridement compared to radiofrequency ablation of the dorsal nerve branch, with durable results. Large scale, randomized trials are warranted to further evaluate the relative efficacy of this surgical treatment in patients with facet joint disease.

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“…There is comparable efficiency of endoscopic facet debridement to radiofrequency ablation of the dorsal nerve [50]. Laser denervation of the dorsal capsule of the facet joint appears to be a more preferable target for facet joint denervation [51].…”

Section: Alternate Techniquesmentioning

confidence: 98%

Untitled

2019

J Musculoskelet Disord Treat

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persists for ≥ 3 months. These acute episodes develop into chronic low back pain (persists more than 3 months) in 8-12% of patients [3]. 85% are non-specific low back pain not attributable to a specific pathology (fracture, infection, osteoporosis, tumour) [4]. Goldthwait, in 1911, was the first to suggest that facet joint could be a source of low back pain. The potential of the zygapophyseal joint as a unique source of lumbar pain has been demonstrated in several histological studies [5]. But interestingly, it was not until 1933, the term "facet syndrome" was used by Ghormley to describe the condition. Pathophysiology This condition is associated with osteoarthritis with the pain originating from the synovium, cartilage and capsule of the facet joint [6]. Two medial branches of the primary dorsal rami (nerve of Luschka) of each spinal nerve innervate a facet joint [7]. The joints are covered by nociceptors with free and encapsulated nerve terminations that contain substance P [8]. It is this facet joint capsule degeneration that is described as "facet syndrome" or "zygapophysial joint pain". Cadaveric studies show that facet arthrosis is present in 100% of the specimens older than 60 years [9]. Eubanks, et al. argue that 57% of patient above the age of 30 years have facet arthrosis [10]. Clinical Tests There are different clinical tests for facet joint pain described in the literature but none of these can reliably distinguish it from other sources of pain. Imaging

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Alternative denervation using laser irradiation in lumbar facet syndrome

Abstract: The dorsal surface of the facet capsule might be a more preferable target for facet denervation.

Cited by 19 publications

References 29 publications

Endoscopic Sacrolumbar Facet Joint Denervation in Osteoarthritic and Degenerated Zygapophyseal Joints

Endoscopic Sacrolumbar Facet Joint Denervation in Osteoarthritic and Degenerated Zygapophyseal Joints

Endoscopic Facet Debridement for the treatment of facet arthritic pain - a novel new technique

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