gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Minimally invasive endoscopic rhizotomy: a treatment for lumbar facet and Iliosacral joint syndrome – technique and clinical experience

Meeting Abstract

  • Alhadi Igressa - Kliniken der Stadt Köln, Klinikum Merheim, Neurochirurgische Klinik, Köln, Deutschland
  • Resul Bulmus - Kliniken der Stadt Köln, Klinikum Merheim, Neurochirurgische Klinik, Köln, Deutschland
  • Habib Bendella - Kliniken der Stadt Köln, Klinikum Merheim, Neurochirurgische Klinik, Köln, Deutschland
  • Makoto Nakamura - Kliniken der Stadt Köln, Klinikum Merheim, Neurochirurgische Klinik, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 133

doi: 10.3205/17dgnc696, urn:nbn:de:0183-17dgnc6962

Published: June 9, 2017

© 2017 Igressa et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Introduction: The facet joint has been implicated as a source of chronic low back pain, especially in degenerative arthritis. The radiofrequency rhizotomy or cryotherapy of the dorsal nerve branches can provide pain relief. The result of the intervention is highly depended on surgeons experience and the positioning of the intervention needles. Anatomic structures were represented only indirectly by X-ray or ultrasound images. In contrast, endoscopy allows a controlled anatomical rhizotomy under direct visualization of the facet joints. Goal of this study is to describe the endoscopic technique, present our clinical experiences and analyse our results.

Methods: We performed endoscopic rhizotomy of the lumbar and sacroiliacal facet joints under general anesthesia in patients who have previously reported at least a pain relief of 50% on the numerical analogue scale (NAS) after infiltration test. We analyzed the surgical technique, the complications during and after intervention, and described advantages and disadvantages compared to other forms of rhizotomies described in the literature. Furthermore, the primary clinical outcome was specified in the relative difference, both at discharge and at the follow-up after 18 months.

Results: A total of 251 patients (158 women, 93 men; mean age 60.37 years; 26-87 years) were included. 1004 facets and 102 sacroiliacal joints were endoscopically thermo frequency coagulated. At discharge, 215 of 251 (85%) and at follow-up study 180 of 251 (72%) patients reported improvement in pain of >50% on the NAS. Complications were minimal and average surgical time per segment was 10 minutes.

Conclusion: Endoscopic rhizotomy of lumbar and sacroiliacal facet joints provided satisfactory results concerning pain control in patients with chronic lumbar back pain. Our preliminary results were very promising concerning the long-term outcome of relief in chronic lumbar back pain. However, further detailed long-term results need to be obtained in the future.