Percutaneous full-endoscopic denervation of lumbar facet joints
Abstract
OBJECTIVE: To study the technique and evaluation of the clinical results of a percutaneous fully endoscopic selective rhizotomy of the medial branch in patients with chronic lumbar pain associated with facet syndrome.
MATERIAL AND METHODS: From February 2017 through February 2019 percutaneous endoscopic rhizotomy of the medial branch of the posterior branch of the spinal nerve in the lumbar spine was performed in 33 patients with chronic back pain associated with facet syndrome. In total, denervation of 69 facet joints was performed: 1 joint (destruction of 2 adjacent medial branches on one side) in 9 cases; 2 joints, one on both sides (destruction of 2 adjacent medial branches on each side) in 10 observations; 2 joints on one side (destruction of 3 adjacent medial branches on one side) in 8 cases; 4 facet joints, 2 on each side (destruction of 3 adjacent medial branches on each side) in 6 observations. To evaluate the results of endoscopic rhizotomy, the ODI questionnaire, VAS and the McNab scale were used. The assessment was made before the operation, the next day, 1, 6, 12 and 24 months after the operation. Statistical analysis of VAS back, ODI indicators before and after surgery in dynamics was performed using the Statistica 7.0 program and Microsoft Excel 2007.
RESULTS: The average severity of preoperative radicular leg pain and back pain for VAS after surgery decreased from 7.5±1.4 and 3.8±1.2 to 1.4±1.2 and 3.5±1.3 in next day; to 1.7±1.4 and 3.2±1.1 after 1 month; to 1.5±1.3 and 2.8±1.4 after 6 months; to 1.6±1.2 and 2.0±1.3 after 12 months; to 1.6±1.2 and 2.0±1.3 after 24 months after operation, respectively (p<0,05). “Excellent” and “good” results of treatment on a scale of McNab evaluated 96,1% patients. The mean value of the ODI improved from 66.4±7.2 to 20.5±3.2 after 1 month; up to 13.6±2.1 after 6 months; up to 12.4±2.3 at 12 months, and to 12.4±2.3 after 24 months surgery, respectively (p<0,05). The average duration of hospitalization of 18±1.4 hours (from 8 to 24 hours). The average severity of preoperative back pain for VAS after surgery decreased from 6.8 ± 1.2 to 3.5 ± 1.2 the next day; up to 2.8 ± 1.3 after 1 month; to 2.2 ± 1.2 after 6 months, to 2.0 ± 1.2 after 12 months and 3.2 ± 1.3 24 months after surgery, respectively (p <0.05) (Fig. 3). On the McNab scale for up to 6 months, treatment results were “excellent” rated by 8 (28.6%) patients, “good” by 15 (53.6%) patients, “satisfactory” 4 (14.3%), “unsatisfactory” — 1 (3.6%) patient. The average ODI value improved from 62.4 ± 6.2 to 20.4 ± 3.2 after 1 month; up to 14.8 ± 2.1 after 6 months; to 12.5 ± 2.1 after 12 months and to 18.4 ± 2.3 24 months after surgery, respectively.
CONCLUSION: Percutaneous endoscopic lumbar facet joint denervation significantly reduced the severity of back pain and improved the quality of life of our patients with chronic back pain for up to 24 months. Endoscopic rhizotomy of the medial branch is a safe and effective alternative treatment method that provides long-term relief of chronic facet pain, especially in patients after microsurgical decompression operations on the spine and previously undergoing insufficiently effective RFA.
About the Authors
A. MeredzhiRussian Federation
Saint-Petersburg
A. Orlov
Russian Federation
Saint-Petersburg
A. Nazarov
Russian Federation
Saint-Petersburg
T. Lalayan
Russian Federation
Saint-Petersburg
S. Singaevskiy
Russian Federation
Saint-Petersburg
V. Bersnev
Russian Federation
Saint-Petersburg
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Review
For citations:
Meredzhi A., Orlov A., Nazarov A., Lalayan T., Singaevskiy S., Bersnev V. Percutaneous full-endoscopic denervation of lumbar facet joints. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2020;12(1):31-37. (In Russ.)