Kryorhizotomy: an alternative technique for lumbar medial branch rhizotomy in lumbar facet syndrome

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> The authors conducted a prospective study to investigate the efficacy of kryorhizotomy, an alternative procedure for lumbar medial branch neurotomy, in the treatment of lumbar facet syndrome (LFS).</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> Fifty patients with chronic low-back pain, in whom pain was relieved by controlled diagnostic medial branch blocks of the lumbar zygapophyseal (facet) joints, underwent lumbar medial branch kryorhizotomy. Outcome was evaluated using the Visual Analog Pain Scales and assessment of work capacity. All outcome measures were repeated at 6 weeks, 6 months, and 1 year after surgery. At 1-year follow-up examination, 31 (62%) of 50 patients experienced a good response to lumbar facet kryorhizotomy. Good results with pain relief of 50% or more were obtained in 85% of patients without previous spinal surgery but only in 46% who had undergone previous spinal surgery. This difference was statistically significant. In five patients (16%) in whom a good initial benefit was observed but who experienced increased pain within 6 weeks after kryorhizotomy, the beneficial result was regained after an early repeated procedure. There were no side effects. Overall, 19 (38%) of 50 procedures were not considered successful. In six of these 19 cases a rigid stabilization of the involved segment provided permanent pain relief.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> Based on this study, patients with LFS who have not undergone previous spinal surgery benefit significantly from percutaneous lumbar kryorhizotomy. Kryorhizotomy, which has virtually no risk, seems to be a valuable alternative technique to lumbar medial branch neurotomy.</jats:p>

Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

“…Another study [92] demonstrated that of the 50 patients who underwent cryoneurolysis (Lloyd Neurostat, Spembly Medical, Hampshire, UK), 62% experienced greater than a 50% reduction in pain (deemed a responder) after 1 year and 76% experienced a reduction in VAS pain score of 3 or more after 1 year. The results also showed that 85% of patients who had not undergone spinal surgery were responders compared to just 47% of those who had undergone previous spinal surgery.…”

Diagnostik und minimal-invasive Therapie bei chronischen Lumbalgien

“…Soll der R. medialis denerviert werden, müssen die benachbarten Segmentversorgungen in die Denervation einbezogen werden. Gute Resultate in der Literatur werden bei 85-95% der behandelten Patienten, richtige Indikation vorausgesetzt, berichtet [2,50].…”

Alternative denervation using laser irradiation in lumbar facet syndrome

“…RF facet denervation was introduced in clinical practice in the early 1970s, and kryorhizotomy was tried in 2003 for the treatment of LFS [3]. Subsequently, highly variable success rates were demonstrated with beneficial outcomes in 11 to 99% of the cases reported in different series [3][4][5][6][7][8].…”

“…Subsequently, highly variable success rates were demonstrated with beneficial outcomes in 11 to 99% of the cases reported in different series [3][4][5][6][7][8].…”