standard-title MultiZYTE® RT INDICATION

MultiZYTE® RT INDICATION

The term „facet syndrome“ was introduced by Ghormley1 in 1933. Shealy2 proposed the use of percutaneous thermocoagulation for the denervation of facet joints in 1976. Based on this technique, Charles Ray and Nikolai Bogduk3,4 introduced radiofrequency neurolysis of the ramus medialis. In 1997, studies by Dreyfuss5 scientifically proved that targeted neurolysis of the ramus medialis can be used to treat pain emanating from the facet joint. The approach of endoscopically controlled radiofrequency facet joint denervation is likely to produce long-lasting pain relief6.

Endoscopic facet joint denervation (rhizotomy)

MultiZYTE® RT can be used for several diagnostic and therapeutic procedures on the spine. These include periradicular therapy (PRT) and facet joint block. All surgery to the spine, including facet joint treatment, must be carefully prepared with a clinical diagnosis, magnetic resonance imaging (MRI) and/or computed tomography (CR), and various conventional X-ray images. Facet joint infiltration provides final verification of the facet joint level generating the pain. If pain stops after infiltration with painkillers, the corresponding nerve branch can be denervated using radiofrequency.

Detail of inflamed facet joint innervation
Click to enlarge

Treatment of the joint capsule

The joint capsule can also be treated during the same procedure depending on the indications. Under endoscopic view, the joint can either be punctured, infiltrated or tissue can be removed. Various instruments are available for this purpose (forceps, shaver blades, RF probes).

Pain therapy with Radiofrequency

In a degenerative facet joint syndrome there is the possibility of minimally invasive infiltration of the respective facet joints. First, under visual control, a local anesthetic is performed to find out whether there is pain relief or disability. If this is the case, the conductivity of the nervous system, which triggers the pain, can be interrupted by radio frequency. The MultiZYTE® RT instrument set are optimally adapted to the various interventions on the spine.

 

When is the endoscopic facet joint treatment recommended?

  • The patient has lumbar back pain that has persisted for more than six weeks and has not responded to conservative management
  • Palpation of the facet joint triggers severe pressure pain and muscle spasms
  • The patient has restricted movement in the lumbar spine, particularly when leaning back
  • A block of the facet joint or medial nerve branch confirms that the facet joint is the source of the pain

 

 In order to reduce the pressure, the facet joint
is opened under endoscopic vision.

Indications

  • Chronic lumbar back pain
  • Facet joint hypertrophy
  • Facet joint arthritis and osteoarthritis
  • Post-discectomy syndrome
  • Cervical spine trauma

 

Benefits of endoscopic facet joint treatment

  • Small incision, therefore hardly any scar tissue
  • Long-term therapy success thanks to the endoscopically controlled procedure
  • Effective and targeted treatment using radiofrequency ablation
  • Treatment of joint capsule with irrigation and vaporization
  • Treatment at multiple levels possible with one incision
  • Short recovery time
  • Can be performed under local anesthesia
  • Spinal mobility is preserved

 

Endoscopic facet joint denervation is a relatively new procedure, for which the initial clinical results are already available including the follow-up period of 1 to 3 years. As a result of the treatment, 90 % of patients experienced a significant reduction in pain (VAS), improvement in physical function and a better quality of life (ODI).7
Click to enlarge

 

 


1) Ghormley, RK.; Low back pain with special reference to the articular facets, with presentation of an operative procedure. JAMA.1933;101:773
2) Shealy CN.; Facet Denervation in the Management of Back and Sciatic Pain. Clin Orthop, 1976;115:157-164
3) Bogduk N.; Zygapophysial blocks and epidural steroids In: Neural Blockade in Clinical Anaesthesia and Management of Pain. 1988:935
4) Bogduk, N.; International Spinal Injection Society guidelines for performance of spinal injection procedures. Part 1: Zygapophysial joint blocks. Clin J Pain.1997;13:285–302
5) Dreyfuss P, Schwarzer AC, Lau P, Bogduk N. Specificity of lumbar medial branch and L5 dorsal ramus blocks. A computed tomography study. Spine. 15. April 1997;22(8):895–902
6) Haufe S. M. W. and Mork A. R.; Endoscopic Facet Debridement for the treatment of facet arthritic pain – a novel new technique Int. J. Med. Sci. 2010, 7
7) Daten aus Yeung et al. 2011, Vorstellung erster klinischer Ergebnisse von insgesamt 205 Patienten und einem Follow-Up im Zeitraum von 1 bis 3 Jahren auf dem ISASS Kongress 2011