Literature References Supporting the Technique Laser Facet Denervation Literature Zh Vopr Neirokhir Im N N Burdenko. 2004 Jan-Mar;(1):20-5; discussion 25-6. [Percutaneous laser denervation of the zygapophyseal joints in the pain facet syndrome] [Article in Russian] Mogalles AA, Dreval' ON, Akatov OV, Kuznetsov AV, Rynkov IP, Plotnikov VM, Minaev VP. Percutaneous laser denervation of archoappendicular joints in spinal pain was made in 15 patients from a study group. Percutaneous high-frequency denervation of archoappendicular joints was performed in a control group consisting of 15 patients with facet syndrome. A preoperative protocol for each patient included at least two diagnostic segmental blocks. A surgical intervention was morphologically substantiated during an experiment; the most optimum surgery protocol was chosen. Destruction was performed by 0.97-micron laser radiation for 4-6 sec at 5-10 W. The number of cases of a complete or partial pain regression, the duration of its impact, side effects and complications were determined. Of the 15 patients from the study group, 8 and 6 patients were observed to have a complete and significant pain regression (more than 50% of the baseline). No effect was achieved in one patient. The similar results were obtained in the control group. There were no postoperative infectious complications in the patients of both groups; transient pain dysesthesia was registered in one case. The findings have led to the conclusion that laser denervation of archoappendicular joints is effective in the pain facet syndrome. Journal of Minimally Invasive Spinal Technology  2004 Twenty patients with arthritis of the facet joint were treated on an outpatient basis by Sri Kantha, M.D., of the Metropolitan Neurology and Spine Institute, Fort Lee, N.J. All of the patients were discharged the same day, with pain medication, muscle relaxants and no restrictions on physical activity. Fifteen or 75 percent of the patients reported significant or partial relief of their lower back pain. In the remaining five patients (25 percent), their back pain was the same as before the procedure. Older patients did not respond as well as younger patients. According to Dr. Kantha: "At least one million people in the United States who suffer from lower back facet joint pain could be successfully treated with the new laser procedure, technically called Laser Lumbar Facet Rhizotomy. The 1-year results of Laser Lumbar Facet Rhizotomy reported in the above paper are superior to procedures using radio frequency (RF) energy, as the laser is more precise, and its pain-relieving effect lasts for years." J Clin Laser Med Surg. 2002 Oct;20(5):251-5. Ablation of bone, cartilage, and facet joint capsule using Ho:YAG laser. Hafez MI, Coombs RR, Zhou S, McCarthy ID. Department of Musculoskeletal Surgery, Division of Surgery, Anaesthesia and Intensive Care, Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom. OBJECTIVE: The objective of this study was to determine of the efficiency of holmium:YAG laser for bone ablation, compared to cartilage and soft tissue of the intervertebral foramen of the lumbosacral spine. BACKGROUND DATA: The holmium:YAG (Ho:YAG) laser has been used for ablation of bulging or prolapsed discs and also has the potential for decompression of the nerve root when there is narrowing of the foraminae (foraminoplasty). It is proposed that laser ablation of bone and ligament of the intervertebral foramen for nerve root decompression using the Ho:YAG laser is able to produce sufficient bone ablation without inducing significant thermal necrosis in surrounding tissues due to its short absorption length, which could result in significant clinical advantages. MATERIALS AND METHODS: Experiments were performed on samples of laminar bone, facet joint capsule, and cartilage for quantitative and qualitative determination of the effect of Ho:YAG ablation on tissue mass loss using a range of pulse energies from 0.5 to 1.5 J/P at 15 pulses/sec. RESULTS: The results showed a significant linear correlation between the mass loss and pulse energy, and between the mass loss and radiant exposure. Electron microscopy and histology showed that the Ho:YAG ablation resulted in a very sharp and clear border with little charring. Applying 0.01 k.J of total energy at two different settings (1.5 J/p, high power, and 0.5 J/p, low power) at 15 pulses/sec, the cross-sectional area/mm(2) of the ablated bone was measured, using light microscopy and the Scion Image analysis program. The ablated areas were 2.28 +/- 0.87 and 1.16 +/- 0.43 mm(2) at high and low power, respectively (p = 0.008). http://www.bonati.com/services/cercical-facet-debridement.html