Reduction of radiation dose during radiofrequency denervation of the lumbar facet joints using the new targeting system SabreSource: a prospective study in 20 patients.
OBJECTIVE
Facet joint denervation is a frequently performed technique to treat facet joint syndrome. Most often this technique is used under fluoroscopic guidance implicating high radiation doses for both patients and surgeons. This prospective study was performed to evaluate the effectiveness in reducing radiation dose during radiofrequency ablation therapy of the lumbar facet joints and to evaluate the feasibility and possibilities of the new real time image guidance system SabreSource.


METHODS
As much as 20 consecutive patients with radiofrequency ablation therapy of the facet joints L4 to S1 were included. Ten patients were treated by fluoroscopic control alone; the following 10 patients were treated with the SabreSource image guidance system. A total of 40 thermal ablations to the facet joints were performed. Each patient was given one thermal ablation on both sides of the vertebral segment, either to the facet joints of L4-L5 or of L5-S1. Pain, according to the visual analogue scale (VAS), was documented before and 6 h after the intervention. Radiation dose, time of radiation and the number of shots needed to place the radiofrequency cannula were recorded.


RESULTS
No complications occurred. Before therapy, the mean VAS in all patients was 7.6 (range 6-10). After therapy the mean VAS in all patients was 3.4 (range 0-5). Compared to the fluoroscopy-guided thermal ablation therapy the SabreSource system significantly reduced the number of fluoroscopy exposures (reduction 23.53%, p = 0.02), the time of radiation exposure (reduction 21.2%, p = 0.03) and the mean entrance surface dose (reduction 30.46%, p = 0.01).


CONCLUSIONS
The SabreSource System reduces radiation exposure and radiation dose in the radiofrequency denervation therapy of the lumbar facet joints and can be applied for other minimally invasive techniques.
Department of Trauma and Orthopaedic Surgery, University Hospital, University of Mainz, Langenbeckstrasse 1, Mainz, Germany. proschek@arcor.de
Dirk
D
Proschek
Konstantinos
K
Kafchitsas
Michael
M
Rauschmann
Andreas
A
Kurth
Thomas
T
Vogl
Florian
F
Geiger
D000368:Aged; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D002908:Chronic Disease; D003714:Denervation / Q000379:methods; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D017116:Low Back Pain / Q000601:surgery; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010147:Pain Measurement; D011446:Prospective Studies; D011829:Radiation Dosage; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000601:surgery*