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Percutaneous cryodenervation of lumbar facet joints: a prospective clinical trial

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Abstract

Facet joint pain is an important aspect of degenerative lumbar spine disease, and radiofrequency medial branch neurotomy remains an established therapy, while cryodenervation has still been poorly examined. This study was undertaken to examine the effects of medial branch cryodenervation in the treatment of lumbar facet joint pain. This was a prospective clinical case series. Patient selection was based on the history, physical examination and positive medial branch blocks. Percutaneous medial branch cryodenervation was performed using a Lloyd Neurostat 2000. Target parameters were low back pain (VAS), limitation of activity (McNab) and overall satisfaction. Fifty patients were recruited, and 46 completed the study. The follow-up time was 1 year. At 6 weeks, 33 patients (72%) were pain free or had major improvement of low back pain; 13 (28%) had no or little improvement. Including failures, mean low back pain decreased significantly from 7.7 preoperatively to 3.2 at 6 weeks, 3.3 at 3 months, 3.0 at 6 months and 4.2 at 12 months (P<0.0001). Limitation of the activities of daily living improved parallel to reduced pain. Our results suggest that medial branch cryodenervation is a safe and effective treatment for lumbar facet joint pain.

Résumé

But de l’étude : les douleurs facétaires articulaires sont un élément important de la pathologie dégénérative de la colonne lombaire et la neurotomie par radio fréquence de la branche médiale est un traitement classique, alors que les résultats de la cryodénervation ne sont pas considérés comme évidents. Cette étude a pour but d’examiner les effets de la cryodénervation des rameaux médians dans le traitement des douleurs facétaires. L’étude a été menée de façon prospective. Les patients ont été sélectionnés selon leur histoire, l’examen physique et la positivité de la réalisation d’une infiltration des rameaux médians. La cryodénervation par voie percutanée a été réalisée par un appareil Lyod Neurostat 2000. Les paramètres étudiés ont été les lombalgies (VAS), la limitation d’activité (McNab) et la satisfaction. Cinquante patients ont été recrutés pour ce traitement, 46 sujets ont été spécialement étudiés et suivis pendant au moins un an. Résultats : à 6 semaines, 33 patients (72%) ne présentent aucune douleur et ont une grande amélioration de leur lombalgie, 13 (28%) n’ont pas ou simplement ont une petite amélioration. Malgré les échecs, les douleurs lombaires diminuent de façon significative avec une échelle de 7.7 préopératoire à 3.2 à 6 semaines, de 3.3 à 3 mois, de 3.0 à 6 mois et 4.2 à 12 mois (P<0.0001). En conclusion, nous pouvons affirmer, aux vues de nos résultats que la cryodénervation des rameaux médians est un procédé donnant de bons résultats réguliers dans le traitement des syndromes facétaires douloureux.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Grosshadern Medical Center, University of Munich, Marchioninistr 15, 81377, Munich, Germany

    C. Birkenmaier, J. Hausdorf, B. Wegener, V. Jansson & C. von Schulze Pellengahr

  2. Medical Park Bad Wiessee St. Hubertus, Sonnenfeldweg 29, 83707, Bad Wiessee, Germany

    A. Veihelmann

  3. Franziskus Hospital, Chirurgie II, Kiskerstr 26, 33615, Bielefeld, Germany

    H. Trouillier

  4. Praxisklinik Leopoldstr 25, 80802, Munich, Germany

    C. Devens

Authors
  1. C. Birkenmaier
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  2. A. Veihelmann
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  3. H. Trouillier
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  4. J. Hausdorf
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  5. C. Devens
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  6. B. Wegener
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  7. V. Jansson
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  8. C. von Schulze Pellengahr
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Correspondence to C. Birkenmaier.

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Birkenmaier, C., Veihelmann, A., Trouillier, H. et al. Percutaneous cryodenervation of lumbar facet joints: a prospective clinical trial. International Orthopaedics (SICO 31, 525–530 (2007). https://doi.org/10.1007/s00264-006-0208-6

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  • DOI: https://doi.org/10.1007/s00264-006-0208-6

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