Improved Treatment Response Following Magnetic Resonance Imaging–Guided Focused Ultrasound for Lumbar Facet Joint Pain

Abstract

Magnetic resonance imagingeguided focused ultrasound (MRgFUS) is a noninvasive modality that allows for precise tissue ablation with sparing of surrounding structures. Early reports of the use of MRgFUS for the treatment of facet joint osteoarthritis are promising. We present a case of facet joint pain treated successfully by MRgFUS at our institution. Magnetic resonance imagingeguided focused ultrasonography may be a useful modality for patients with facet jointemediated low back pain, particularly in the setting of limited or refractory response to conventional treatments.

Magnetic Resonance Imaging–Guided Focused Ultrasound Ablation of Lumbar Facet Joints of a Patient With a Magnetic Resonance Image Non-Conditional Pacemaker at 1.5T

“…We report a first case of MRgFUS ablation of lumbar facet joints in a patient with refractory low back pain and MRI non-conditional pacemaker. Facet joint MRgFUS is a relatively new treatment for facet joint pain 8,10,11 ; this procedure has the advantage of not requiring skin incision, and uses MRI for treatment planning and monitoring of the ablation in the real-time.…”

“…Therefore, MRgFUS ablation treatment of the bilateral L3-4, L4-5, and L5-S1 facet joint capsules was performed as has been described previously. 8 The patient's medical history was significant for coronary artery disease, hypertension, and symptomatic sinus bradycardia (50 beats/ min and 2:1 block), which led to placement of a dual chamber transvenous pacemaker system in 2015 (Assurity DR 2240 pulse generator, Model 1642T right atrial lead, Model 1646T right ventricular lead, all MRI nonconditional, Abbott, IL) in the right chest. The patient was not pacemaker-dependent.…”

“…Therefore, MRgFUS ablation treatment of the bilateral L3-4, L4-5, and L5-S1 facet joint capsules was performed as has been described previously. 8 …”

“…MRgFUS ablation of the bilateral L3-4, L4-5, and L5-S1 facet joints was performed, the exact details of the treatment protocol are described in Tiegs-Heiden et al. 8 In summary, target accuracy was confirmed at a low-power test dose of 18 W, and the treatment doses were between 40 and 60 W with each sonication lasting 25 s. A total of 22 individual sonications were delivered during the procedure, which lasted 206 min in total. Each sonication was monitored in the axial plane using phase-sensitive gradient-recalled echo sequences (SAR, 0.01W/kg) acquired for the purpose of real-time MR thermometry feedback with temporal resolution of 6 s. Following each sonication, the patient was asked to rate his pain level on a scale of 0 to 10 and the sonication position and energy was modulated based on the patient’s rated pain score.…”

“…1 MRgFUS systems have been successfully used to treat a variety of conditions, such as symptomatic uterine fibroids, [1][2][3][4] essential tremor, 5,6 prostate cancer, 7 and facet joint pain. 8 Facet joint treatments in our practice use the Exablate 2100 MRgFUS system (Insightec, Haifa, Israel) integrated with a 60-cm bore 1.5-T MR scanner (Signa Excite, General Electric, Waukesha, WI). The use of MRI can pose significant safety challenges for patients with cardiac implanted electronic devices (CIEDs), potentially excluding them from treatment.…”