Neurotomy In Treatment Research Articles

Radiofrequency Facet Joint Neurotomy in Treatment of Facet Syndrome

Retrospective analyses of 50 patients with lumbar facet syndrome treated with lumbar facet joint neurotomy. To establish the efficacy of lumbar facet joint neurotomy under optimum conditions in selected patients. With the realization of the significance of facet joints in the etiology of chronic low back pain over the last decade, many studies were conducted about various methods of treating the facet joint syndrome. Fifty patients with lumbar facet syndrome with at least 80% pain relief by controlled, diagnostic medial branch blocks underwent lumbar facet joint neurotomy. Before surgery, all were examined carefully both clinically and radiologically and evaluated by visual analog scale (VAS) and descriptive system of health-related quality of life state (EQ5D) measures of pain, disability, and treatment satisfaction. All outcome measures were repeated postoperatively and at 12 months after surgery. Of the 50 patients 35 were females and 15 were males with a mean age of 51.82±16.99 years. One level was treated in 26 patients, 2 levels in 14, 3 levels in 8, and 4 levels were treated in 2 patients. Symptom duration was ranging between 2 and 24 months with a mean of 7.64±5.98 months. Mean preoperative, postoperative, and at the 12th month VAS were 75.2±11.29, 23.8±10.28, and 24.6±11.817, respectively.Forty-eight percent of patients obtained a relative reduction of at least 70% in VAS, and 86% obtained a reduction of at least 60% at the 12th month. Health-related quality of life state was improved in all patients. When the VAS scores were evaluated with respect to the ages of patients, level numbers, and preoperative symptom duration, no significant differences were found, [0.106, 0.635 and 0.526 (preoperative VAS); 0.033, 0.555, and 0.235 (postoperative VAS); 0.701, 0.978, and 0.155 (follow-up VAS), respectively]. The most important factors determining success of this procedure is strict patient selection criteria and technique of the procedure.

Peripheral selective neurotomy of the brachial plexus collateral branches for treatment of the spastic shoulder: anatomical study and clinical results in five patients.

A new type of peripheral selective neurotomy involving the collateral branches of the brachial plexus has been perfected for treatment of the spastic shoulder. Anatomical study of six cadaveric shoulders led to the specification of a surgical approach to the pectoralis major and teres major nerves, which innervate the main muscles implicated in shoulder spasticity. Between August 1994 and September 1995, five patients (four men and one woman) underwent two to four associated neurotomies of the upper limb, which included neurotomies of the pectoralis major (all five patients) and the teres major (two patients). The average follow-up period was 11 months, during which there were no local or general complications. The spasticity of the treated muscles resolved in all five patients (Held score range 3-0). The neurotomies led to statistically significant average amplitude increases in shoulder mobility, especially in abduction (+30 degrees), antepulsion (+50 degrees), retropulsion (+20 degrees), and external rotation (+20 degrees). The functionally useful active amplitude scores increased from 2.66 to 5.16/6. This functional improvements mainly involved the standing position and walking stability, as well as improvement in the range of motion of the lower limb. These results encourage the increasing use of this new type of neurotomy in treatment of the spastic upper limb.