title: Computerized tomography-guided kryorhizotomy in 76 patients with lumbar facet joint syndrome.
abstract: OBJECTIVE
  The authors prospectively evaluated the therapeutic effect of computerized tomography (CT)-guided kryorhizotomy in the treatment of patients with lumbar facet joint syndrome (LFJS) and assessed prognostic factors that predict this effect.
  
  
  METHODS
  Between February 2001 and March 2004, CT-guided kryorhizotomy of facet joints was performed in 76 patients with LFJS. A diagnosis was established after three positive CT-guided medial nerve branch blocks. Outcome was determined by evaluating the results of a standardized questionnaire, including visual analog scale (VAS) score, use of medication, ability to work, and physical conditions. Measurement was performed before treatment and repeated postoperatively at 3 days, 3 months, and every 6 months thereafter. On September 2004 all patients underwent clinical reevaluation. The median follow-up period was 22.5 months (range 6-43 months); the median interval to pain reduction was 6 months (range 0.1-31 months) after the first kryorhizotomy. The mean VAS pain score was 6.7 preoperatively and 2.9, 3.2, and 3.4 at 3 days, 3 months, and 6 months postoperatively, respectively. In 40% of patients pain was reduced for 12 months or longer. In patients in whom there was no prior surgical treatment of the relevant spinal segment, the duration of pain relief was significantly longer than in patients who had previously undergone surgery (p < 0.03). Eighteen patients underwent a second, seven a third, and one a fourth kryorhizotomy. No patient reported any side effect. The use of CT guidance guarantees an exact needle-tip position control and documentation for repeated procedures.
  
  
  CONCLUSIONS
  Computerized tomography-guided kryorhizotomy is a minimally invasive and repeatable treatment that yields good long-term results in patients with LFJS.
authors.affiliation: Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians- University, Munich, Germany. marko.staender@med.uni-muenchen.de
authors.forename: Marko
authors.initials: M
authors.lastname: Staender
authors.forename: Ulrich
authors.initials: U
authors.lastname: Maerz
authors.forename: Jörg Christian
authors.initials: JC
authors.lastname: Tonn
authors.forename: Ulrich
authors.initials: U
authors.lastname: Steude
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000473:pathology / Q000601:surgery*; D017116:Low Back Pain / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation; D019051:Rhizotomy / Q000379:methods*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D021801:Zygapophyseal Joint / Q000473:pathology / Q000601:surgery