Laser-guided lumbar medial branch kryorhizotomy

Technical note

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  • 1 Department of Neurosurgery, Stanford University Medical Center, Stanford, California;
  • 2 Department of Neurosurgery, University of Berne, Inselspital, Berne;
  • 3 Division of Spine Surgery, Stephanshorn Clinic, St. Gallen;
  • 4 Leuag AG, Stans; and
  • 5 Department of Neurosurgery, Kantonsspital Aarau, Switzerland
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The authors describe a modification of the medial branch kryorhizotomy technique for the treatment of lumbar facet joint syndrome using a fluoroscopy-based laser-guided method. A total of 32 patients suffering from lumbar facet joint syndrome confirmed by positive medial nerve block underwent conventional or laser-guided kryorhizotomy. The procedural time (20.6 ± 1.0 vs 16.3 ± 0.9 minutes, p < 0.01), fluoroscopy time (54.1 ± 3.5 vs 28.2 ± 2.4 seconds, p < 0.01), radiation dose (407.5 ± 32.0 vs 224.1 ± 20.3 cGy/cm2, p < 0.01), and patient discomfort during the procedure (7.1 ± 0.4 vs 5.2 ± 0.4 on the visual analog scale, p < 0.01) were significantly reduced in the laser-guided group. There was a tendency for a better positioning accuracy when the laser guidance method was used (3.0 ± 0.3 vs 2.2 ± 0.3 mm of deviation from the target points, p > 0.05). No difference in the outcome was observed between the 2 groups of patients (visual analog scale score 3.5 ± 0.2 vs 3.3 ± 0.3, p > 0.05). This improved minimally invasive surgical technique offers advantages to conventional fluoroscopy-based kryorhizotomy.

Abbreviations used in this paper:BMI = body mass index; LFJS = lumbar facet joint syndrome; VAS = visual analog scale.

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Contributor Notes

Address correspondence to: Robert H. Andres, M.D., Department of Neurosurgery, Stanford University Medical Center, 1201 Welch Road, MSLS P304, Stanford, California 94305. email: randres@stanfordmedalumni.org.
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