Article
CT guided cryorhizotomy in 66 patients with a lumbar facet syndrome
CT-gestützte Kryotherapie bei 66 Patienten mit lumbalem Facettsyndrom
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Authors
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Marko Ständer
- Ludwig-Maximilians-Universität München, Universitätsklinikum Großhadern, Klinik für Neurochirurgie
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M. Stander
- Neurochirurgische Klinik, Klinikum Grosshadern, Ludwig-Maximilians-Universität, München
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U. Steude
- Neurochirurgische Klinik, Klinikum Grosshadern, Ludwig-Maximilians-Universität, München
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J.-C. Tonn
- Neurochirurgische Klinik, Klinikum Grosshadern, Ludwig-Maximilians-Universität, München
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U. März
- Neurochirurgische Klinik, Klinikum Grosshadern, Ludwig-Maximilians-Universität, München
| Published: | April 23, 2004 |
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Outline
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Objective
To evaluate prospectively the therapeutic effect of CT-guided cryorhizotomy on patients with lumbar facet syndrome and to evaluate prognostic factors to predict this effect.
Methods
Between February 2001 and January 2003 CT-guided cryorhizotomy of the facet joint was performed on 66 patients with lumbar facet syndrome (LFS). LFS was diagnosed by at least 3 positive CT-guided medial nerve branch blocks. We used the same target points for medial nerve branch blocks and cryorhizotomy. Patient evaluation were done by clinical evaluation. Patient's follow-up includes a telephone interview 3 days after the procedure and a clinical examination 3 weeks, 3 months and 6 months after cryorhizotomy. In July and August 2003 all patients were clinically reevaluated. Before treatment and on all evaluation points patients had to complete a standardized questionnaire including VAS-scale, medications, ability to work and physical conditions.
Results
The median follow-up was 12 months (7-30 months), median age of patients population was 62 years (30-93 years), 30 patients were male, 36 female. Medium pain free interval was 7 months (0.1-31 months). 65% of patients are pain free for 6 months or longer. Patients without prior operation at the relevant spinal segment had a significantly longer pain-free interval than patients with prior operation (p<0.03). 15 patients got a second, two patients a third cryorhizotomy at the relevant segment. The pain free-interval after the second cryorhizotomy was in the range of the first cryorhizotomy (p>0.5). No patients reported side effects. 3 patients underwent transpedicular fusion after cryorhizotomy. CT-guidance guarantiees an exact needle control and reliable needle positioning for cryorhizotomy with only 12% needle correction.
Conclusions
CT-guided cryorhizotomy is a minimal invasive alternative treatment strategy for patients with lumbar facet syndrome. Cryorhizotomy is specially interesting for patients with risk factors for anesthesia, like old patients and patients with a high cardiac risk profile. In case of pain recurrence, a second cryorhizotomy can be performed. In general, results are better in patients without prior operation of the relevant segment.
