title: Laser-guided lumbar medial branch kryorhizotomy.
abstract: 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/cm(2), 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.
authors.affiliation: Department of Neurosurgery, Stanford University Medical Center, Stanford, California 94305, USA. randres@stanfordmedalumni.org
authors.forename: Robert H
authors.initials: RH
authors.lastname: Andres
authors.forename: Thilo
authors.initials: T
authors.lastname: Graupner
authors.forename: Christian B
authors.initials: CB
authors.lastname: Bärlocher
authors.forename: Arthur
authors.initials: A
authors.lastname: Augsburger
authors.forename: Javier
authors.initials: J
authors.lastname: Fandino
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007834:Lasers; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010146:Pain / Q000209:etiology; D056888:Patient Positioning; D011829:Radiation Dosage; D019051:Rhizotomy / Q000295:instrumentation* / Q000379:methods*; D013122:Spinal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000601:surgery*