POTENTIAL OF ULTRASOUND-GUIDED LUMBAR FACET RADIOFREQUENCY DENERVATION

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Abstract

The aim of the study was to evaluate the possibility of US navigation for Radiofrequency denervation (RFD) of the lumbar facets.

Material and methods. The authors performed a prospective controlled cohort study which included 50 patients with chronic pain syndrome who underwent RFD LIII-SI facets on both sides. The main group (US) included 25 patients, who underwent US guided navigation with FScontrol of the correct placement of the cannula prior to ablation. In the control group (FS) the RFD was performed only under FS control. Patients were selected after preliminary test block of medial branch with 50% pain reduction from the baseline. Patients with overweight, spinal deformity, pronounced degenerative changes, spinal stenosis and developmental anomalies were not included in the study. For the evaluation of outcomes, the numeric pain scale NRS-11 and the Oswestry index (ODI) were used, the accuracy of the cannula position was assessed and factors determining the accuracy were searched.

Results. As a result of the intervention, there was a significant decrease of NRS-11 and ODI criteria in both groups (p<0.001), a positive outcome was achieved in 18 (72%) of US patients and 16 (64%) of FS patients, p = 0.564. Of the 200 attempts to position the cannula under the ultrasound control, 169 (84.5%) were successful, in most cases (187 out of 200, 93.5%) at least 3 attempts were required to reposition the cannula. The average time for performing the procedure under the ultrasound control was 47.3±1.13 minutes. The facet angle and procedure level were defined as predictors of the cannula positioning accuracy, odds ratio 0.93 (95% CI 0.894–0.963) and 0.51 (95% CI 0.32–0.805), respectively.

Conclusion. RFD of lumbar facet under ultrasound navigation allows to achieve a relatively high accuracy of the cannula position into the zone of passage of the articular branch. The navigation capabilities are reduced at the level of LV and SI vertebrae due to structural features of the joints, namely coronary orientation of the facets with the formation of a narrow space between the transverse and upper articular process, which create difficulties for scanning. The disadvantage of ultrasound control is the lengthy procedure and the need for repeated reinsertion of the cannulae worsening the patient’s tolerance of procedure.

About the authors

I. V. Volkov

Vreden Russian Research Institute of Traumatology and Orthopedics; Nikiforov Russian Center of Emergency and Radiation Medicine

Author for correspondence.
Email: ivanvolkov@yandex.ru

Ivan V. Volkov — Cand. Sci. (Med.), Senior Researcher VRRITO; Neurosurgeon Nikiforov RCERM.

8, ul. Akad. Baykova, St. Petersburg, 195427; 54, ul. Optikov, St. Petersburg, 197345 Россия

I. Sh. Karabaev

Nikiforov Russian Center of Emergency and Radiation Medicine

Email: fake@neicon.ru

Igor’ Sh. Karabaev — Cand. Sci. (Med.), Associate Professor, Head of neurosurgical department..

54, ul. Optikov, St. Petersburg, 197345 Россия

D. A. Ptashnikov

Vreden Russian Research Institute of Traumatology and Orthopedics; Mechnikov North-Western State Medical University

Email: fake@neicon.ru

Dmitry A. Ptashnikov — Dr. Sci. (Med.), Professor, Head of Spinal Surgery and Oncology Department, Vreden Russian Research Institute of Traumatology and Orthopedics; Head of Traumatology and Orthopedic department, MNWSMU.

8, ul. Akad. Baykova, St. Petersburg, 195427; 41, Kirochnaya ul., St. Petersburg, 191015

Россия

N. A. Konovalov

Burdenko National Scientific and Practical Center for Neurosurgery

Email: fake@neicon.ru

Nikolai A. Konovalov — Сorresponding member of RAS, Dr. Sci. (Med.), Head of Spinal Department.

16, 4th Tverskaya-Yamskaya ul., Moscow, 125047 Россия

K. A. Poyarkov

Nikiforov Russian Center of Emergency and Radiation Medicine

Email: fake@neicon.ru

Konstantin A. Poyarkov — neurosurgeon.

54, ul. Optikov, St. Petersburg, 197345 Россия

References

  1. Eubanks J.D., Lee M.J., Cassinelli E., Ahn N.U. Prevalence of lumbar facet arthrosis and its relationship to age, sex, and race: an anatomic study of cadaveric specimens. Spine (Phila Pa 1976). 2007;32(19):2058-2062. doi: 10.1097/brs.0b013e318145a3a9.
  2. Kalichman L., Li L., Kim D.H., Guermazi A., Berkin V., O’Donnell C.J., Hoffmann U., Cole R., Hunter D.J. Facet joint osteoarthritis and low back pain in the communitybased population. Spine (Phila Pa 1976). 2008;33(23): 2560-2565. doi: 10.1097/brs.0b013e318184ef95.
  3. Da Rocha I.D., Cristante A.F., Marcon R.M., Oliveira R.P., Letaif O.B., de Barros Filho T.E.P. Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up. Clinics (Sao Paulo). 2014;69(8):529-534. doi: 10.6061/clinics/2014(08)05.
  4. Manchikanti L., Abdi S., Atluri S., Benyamin R.M., Boswell M..V, Buenaventura R.M. et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronicspinal pain. Part II: guidance and recommendations. Pain Physician. 2013;16 (2 Suppl):S49-283.
  5. Manchikanti L., Manchukonda R., Pampati V., Damron K.S., McManus C.D. Prevalence of facet joint pain in chronic low back pain in postsurgical patients by controlled comparative local anesthetic blocks. Arch Phys Med Rehabil. 2007;88 (4):449-455. doi: 10.1016/j.apmr.2007.01.015
  6. Falco F.J.E., Manchikanti L., Datta S., Sehgal N., Geffert S., Onyewu O. et al. An update of the effectiveness of therapeutic lumbar facet joint interventions. Pain Physician. 2012;15(6):E909-953.
  7. van Zundert J., Vanelderen P., Kessels A., van Kleef M. Radiofrequency treatmentof facet-related pain: Evidence and controversies. Curr Pain Headache Rep. 2012;16(1): 19-25. doi: 10.1007/s11916-011-0237-8.
  8. Hurdle M.F. Ultrasound-GuidedSpinal Procedures for Pain: A Review. Phys Med Rehabil Clin N Am. 2016;27(3):673-686. doi: 10.1016/j.pmr.2016.04.011.
  9. Greher M., Scharbert G., Kamolz L.P., Beck H., Gustorff B., Kirchmair L., Kapral S. Ultrasound-guided lumbar facet nerve block: a sonoanatomic study of a new methodologic approach. Anesthesiology. 2004;100(5): 1242-1248.
  10. Greher M., Kirchmair L., Enna B., Kovacs P., Gustorff B., Kapral S., Moriggl B. Ultrasound-guided lumbar facet nerve block: accuracy of a new technique confirmed by computed tomography. Anesthesiology. 2004;101(5):1195-1200.
  11. Shim J.K., Moon J.C., Yoon K.B., Kim W.O., Yoon D.M. Ultrasound-guided lumbar medial-branch block: a clinical study with fluoroscopy control. Reg Anesth Pain Med. 2006;31(5):451-454. doi: 10.1016/j.rapm.2006.06.246.
  12. Han S.H., Park K.D., Cho K.R., Park Y. Ultrasound versus fluoroscopy-guided medial branch block for the treatment of lower lumbar facet joint pain: A retrospective comparative study. Medicine (Baltimore). 2017;96(16):e6655. doi: 10.1097/MD.0000000000006655.
  13. Weishaupt D., Zanetti M., Boos N., Hodler J. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol. 1999;28(4):215-219. doi: 10.1007/s002560050503.
  14. Hanu-Cernat D.E., Duarte R., Raphael J.H., Mutagi H., Kapur S., Senthil L. Type of interventional pain procedure, body weight, and presence of spinal pathology are determinants of the level of radiation exposure for fluoroscopically guided pain procedures. Pain Pract. 2012;12(6):434-439. doi: 10.1111/j.1533-2500.2011.00521.x
  15. Choi M.H., Choi B.G., Jung S.E., Byun J.Y. Factors related to radiation exposure during lumbar spine intervention. J Korean Med Sci. 2016;31(Suppl 1):S55-S58. doi: 10.3346/jkms.2016.31.S1.S55.
  16. Коновалов Н.А., Прошутинский С.Д., Назаренко А.Г., Королишин В.А. Радиочастотная денервация межпозвонковых суставов при лечении болевого фасеточного синдрома. Вопросы нейрохирургии. Журнал им. Н.Н. Бурденко. 2011;75(2):51-55. Konovalov N.A., Proshutinskii S.D., Nazarenko A.G., Korolishin V.A. [Radiofrequency denervation of intervertebral joints in management of facet pain syndrome]. Zhurnal “Voprosy neirokhirurgii” im. N.N. Burdenko [Burdenko’s Journal of Neurosurgery]. 2011;75(2):51-55. (in Russian).
  17. Rubinstein S.M., van Tulder M. A best-evidence review of diagnostic procedures for neck and low-back pain. Best Pract Res Clin Rheumatol. 2008;22(3):471-482. doi: 10.1016/j.berh.2007.12.003.
  18. Derby R., Melnik I., Lee J.E., Lee S.H. Correlation of lumbar medial branch neurotomy results with diagnostic medial branch block cutoff values to optimize therapeutic outcome. Pain Med. 2012;13(12):1533-1546. doi: 10.1111/j.1526-4637.2012.01500.x.
  19. Rauch S., Kasuya Y., Turan A., Neamtu A., Vinayakan A., Sessler D.I. Ultrasound-guided lumbar medial branch block in obese patients: a fluoroscopically confirmed clinical feasibility study. Reg Anesth Pain Med. 2009;34(4): 340-342. doi: 10.1097/aap.0b013e3181ada563.
  20. Greher M., Moriggl B., Peng P.W., Minella C.E., Zacchino M., Eichenberger U. Ultrasound-guided approach for l5 dorsal ramus block and fluoroscopic evaluation in unpreselected cadavers. Reg Anesth Pain Med. 2015;40(6):713-717. doi: 10.1097/AAP.0000000000000314.
  21. Cosman E.R.Jr, Dolensky J.R., Hoffman R.A. Factors that affect radiofrequency heat lesion size. Pain Med. 2014;15(12):2020-2036. doi: 10.1111/pme.12566.
  22. Cohen S.P., Hurley R.W., Christo P.J., Winkley J., Mohiuddin M.M., Stojanovic M.P. Clinical predictors of success and failure for lumbar facet radiofrequency denervation. Clin J Pain. 2007;23(1):45-52. doi: 10.1097/01.ajp.0000210941.04182.ea.
  23. Cohen S.P., Strassels S.A., Kurihara C., Lesnick I.K., Hanling S.R., Griffith S.R., Buckenmaier C.C., Nguyen C. Doessensory stimulation threshold affect lumbar facet radiofrequency denervation outcomes? A prospective clinical correlational study. Anesth Analg. 2011;113(5):1233-1241. doi: 10.1213/ANE.0b013e31822dd379.
  24. Masharawi Y., Rothschild B., Salame K., Dar G., Peleg S., Hershkovitz I. Facet tropism and interfacet shape in the thoracolumbar vertebrae: characterization and biomechanical interpretation. Spine (Phila Pa 1976). 2005;30(11):E281-292. doi: 10.1097/01.brs.0000164098.00201.8d
  25. Masharawi Y., Rothschild B., Dar G., Peleg S., Robinson D., Been E, Hershkovitz I. Facet orientation in the thoracolumbar spine: three-dimensional anatomic and biomechanical analysis. Spine (Phila Pa 1976). 2004;29(16):1755-1763. doi: 10.1097/01.brs.0000134575.04084.ef.
  26. Rahimzadeh P., Faiz H.R., Baghaee A.R., Nader N.D. Sonoanatomic indices of lumbar facet joints in patients with facetogenic back pain in comparison to healthy subjects. J Clin Anesth. 2017;36:67-71. doi: 10.1016/j.jclinane.2016.10.005.

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