| Laser facet neurotomy is a technique developed to treat facet arthropathy and was developed bySri Kantha, MD. The technique is an alternative to the much more common radiofrequency neurotomy for the treatment of low back pain due to arthritis of the facet joints of the low back and tears of the capsule surrounding the facet joint. WHY USE A LASER WHEN RADIOFREQENCY IS MORE COMMONLY USED? Laser neurotomy produces several fine cuts across the nerve to the facet joint instead of a lenthwise burning of the nerve. Therefore the laser procedure more accurately targets the nerve to the facet joint (medial branch) and appears to result in a more complete interruption of the pain pathway. This translates to a potential longer term effect. Also, the anatomy of the facet joint is known to have several nerve branches which enter the joint from the front and over the top of the joint which may be missed by traditional radiofrequency neurotomy. Laser facet neurotomy may permit more extensive targeting of these nerves. HOW IS THE PROCEDURE PERFORMED? The patient lies face down on an operating room table and has a surgical skin preparation and sterile draping applied. Heavy sedation is usually used for this procedure. A small amount of local anesthetic is placed into the skin, and the facet laser handpiece is inserted through the skin and advanced to the area of the nerve to the facet joint. This nerve does not go to the legs or anywhere else but the back. Laser energy in small amounts is used to destroy the nerves to the joints. Following completion of the procedure, the patient usually returns to home in less than one hour. Pain relief usually begins 1-3 weeks later with an initial flare-up of pain for about 1 week in 10% of patients. IS IT EFFECTIVE? In a study by Sri Kantha in the Journal of Minimal Invasive Spinal Technology in 2004, the reported rate of success is 75%. A study by Mork reports 73% and a Russian study in 2004 reported 53% complete relief and another 44% with more than 50% relief. IS THIS EXPERIMENTAL? Yes and no. Yes in that the handpiece has not been approved by the FDA. No in that neurodestruction of the nerve by any means (including laser), is a covered CPT code by most insurance carriers. The technique is taught only by the most advanced pain management physicians in the USA and is taught in courses sponsored by the American Board of Interventional Pain Medicine. Dr. Kantha has performed the procedure well over 10,000 times and Dr. Whitworth has performed the procedure since 2001. ARE THERE POSSIBLE COMPLICATIONS TO THE PROCEDURE? Bleeding, infection, nerve injury, muscle bruising or hematoma, nerve injury, or spinal injury. All these are very rare since the procedure is performed under fluoroscopic guidance. Since the laser penetrates tissue only 400 microns, potential damage to distant structures is very remote. When used below the level of L1 (the end of the spinal cord itself), the risk of spinal cord damage is extremely rare. WHAT ARE THE ALTERNATIVES TO THE PROCEDURE? Radiofrequency neurotomy and cryoneurolysis of the facet joints; fusion of the spine. Currently there are investigations into other types of facet fixation with pins but this has not met with widespread enthusiasm. There are a few centers in the country beginning to design artifical facet joints, but it will require many years of research prior to the implementation of these devices. |
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| Laser Facet Neurotomy |
