Facet Rhizotomies: Burning more times better?

[ans]

I read on another forum that a patient got an excellent response by his doc who on giving a facet rhizotomy, burned the area six times versus once.

I wonder if this makes an appreciable difference. If you note to docs in the procedure areas, it seems that they are literally running from one pt. to another - to me as 'tho on an assembly line.

If this makes a difference, oh I would dig finding an interventionist who accepts BC for my next one. How many chances do we have with those darning-needle sized things/re: scar tissue.

(Also, how many rhizotomies can one get for year?).

Any answers would be great! Thansk.

[annapurna]

When you mean burning six times, do you mean inert the needle once and zap it six times? If that's what you meant, then multiple zaps is standard based on Laura's two rhizos. Once you get the needle set right, you zap once lightly to make sure you've got the right thing, harder a second time and more times as needed until the doc and patient think it worked. If it's insert, zap, and pull the needle out, then repeat; then I'd tell you to stay away from someone like that. Setting the needle in the right place is the hardest part of the work; why would you want to repeat that?

As for a good doc, we liked one guy in Regensburg, Germany. The commute to his office would be rough for you but Laura's had some success in filing some things with BC as a out of network provider.

[Harrison]

I have heard/read reports from patients on this forum that there are several variables to consider when aiming for pain eradication:

- technique variance: the doctor's training, how the RF is applied;
- technology variance: different ways of employing RF to affected nerves because of varying probe designs, as well as the duty cycle and amplitude of RF waves;
- number of procedures: some say more applications are better.

This is an important subject but I don't see detailed, current information available. Any good articles from THIS DECADE would be appreciated!

[Harrison]

The Role Of Radiofrequency Facet Denervation In Chronic Low Back Pain
Jerry A. Hall, M.D.
http://www.coccyx.org/medabs/hall.htm

__________________________________________________ _____________


CyberKnife rhizotomy for facetogenic back pain: a pilot study.
Li G, Patil C, Adler JR, Lad SP, Soltys SG, Gibbs IC, Tupper L, Boakye M.

Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.

OBJECT: By targeting the medial branches of the dorsal rami, radiofrequency ablation and facet joint injections can provide temporary amelioration of facet joint-producing (or facetogenic) back pain. The authors used CyberKnife radiosurgery to denervate affected facet joints with the goal of obtaining a less invasive yet more thorough and durable antinociceptive rhizotomy.

METHODS: Patients with refractory low-back pain, in whom symptoms are temporarily resolved by facet joint injections, were eligible. The patients were required to exhibit positron emission tomography-positive findings at the affected levels. Radiosurgical rhizotomy, targeting the facet joint, was performed in a single session with a marginal prescription dose of 40 Gy and a maximal dose of 60 Gy.

RESULTS: Seven facet joints in 5 patients with presumptive facetogenic back pain underwent CyberKnife lesioning. The median follow-up was 9.8 months (range 3-16 months). The mean planning target volume was 1.7 cm(3) (range 0.9-2.7 cm(3)). A dose of 40 Gy was prescribed to a mean isodose line of 79% (range 75-80%). Within 1 month of radiosurgery, improvement in pain was observed in 3 of the 5 patients with durable responses at 16, 12, and 6 months, respectively, of follow-up. Two patients, after 12 and 3 months of follow-up, have neither improved nor worsened. No patient has experienced acute or late-onset toxicity.

CONCLUSIONS: These preliminary results suggest that CyberKnife radiosurgery could be a safe, effective, and non-invasive alternative to radiofrequency ablation for managing facetogenic back pain. No patient suffered recurrent symptoms after radiosurgery. It is not yet known whether pain relief due to such lesions will be more durable than that produced by alternative procedures. A larger series of patients with long-term follow-up is ongoing.

[ans]

I know what you mean A. but I read on my surgical report that I was zapped twice. Can't help but wonder if I would have had a longer pain remission if they burnt it to the crisp!

I too saw that article on the Cyber-Knife and wonder about its efficacy!

Oh when will we know.