Document Detail

CyberKnife rhizotomy for facetogenic back pain: a pilot study.
MedLine Citation:
PMID:  18081475     Owner:  NLM     Status:  MEDLINE    
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.
Gordon Li; Chirag Patil; John R Adler; Shivanand P Lad; Scott G Soltys; Iris C Gibbs; Laurie Tupper; Maxwell Boakye
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurosurgical focus     Volume:  23     ISSN:  1092-0684     ISO Abbreviation:  Neurosurg Focus     Publication Date:  2007  
Date Detail:
Created Date:  2007-12-17     Completed Date:  2008-02-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100896471     Medline TA:  Neurosurg Focus     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E2     Citation Subset:  IM    
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
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MeSH Terms
Aged, 80 and over
Back Pain / pathology,  surgery*
Follow-Up Studies
Middle Aged
Pilot Projects
Radiosurgery / methods*
Rhizotomy / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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