Endoscopic Facet Joint Denervation (Rhizotomy)

Endoscopic Facet Joint Denervation (Rhizotomy)
Pain treatment with Radiofrequency
C O N C E P T
Endoscopic Facet Joint Denervation – Rhizotomy
In our aging societies back pain diseases are wide spread and common diseases. The differential diagnosis of facet joint pain is even
more common amongst other diagnosed back pain causes.
mentation of the required treatment. The use of the endoscopic view
can reduce radiation exposure from other real time imaging techniques such as X-ray or CT.
The endoscopic access to the facet joints is a true minimally invasive
method. In one intervention, the cause of the pain can be determined
by locating the inflamed nerve, followed by the immediate imple-
This therapy consists of a long term ablation of the nerve fibers
generating the pain1, 3). There are no additional risks associated with
repeating the procedure should pain reoccur.
A P P L I C A T I O N
Indications
• Chronic low back pain
• Facet joint hypertrophy
• Facet joint arthritis
• Failed back syndrome
• Sciatica
• Whiplash syndrome
When is Facet Joint Denervation / Rhizotomy recommended?
• The patient has lower back pain longer than 6 weeks with no
response to conservative treatments
• Palpation of the facet joints causes muscle spasm and deep
tenderness
• Patient has restricted range of movement in the lumbar spine,
particularly when bending backwards
• Blocking the facet joint or medial branch nerve confirms that
lower back pain is caused by the facet joint
An inflamed facet joint is often the cause of lower back pain
Advantages of Facet Joint Denervation / Rhizotomy
• Minimally invasive procedure
• Small incision and minimal scar tissue
• Outpatient procedure possible
• Short recovery time
• High success rate and
Ramus medialis
sustained success of the therapy1)
• No or minimal blood loss
• Possible use of local anesthesia
• Spinal mobility is maintained
• Visual endoscopic control of the treatment
2
1)
Scott M.W. Haufe, Anthony R. Mork: Endoscopic Facet Debridement for the treatment
of facet arthritic pain – a novel new technique
In: International Journal of Medical Sciences, 2010; 7(3):120-123
2)
A. Igressa (Köln-Merheim): First results after endoscopic facet joint denervation,
27.09.2013 – DGNC Spine Section Conference, Frankfurt, Germany
3)
Siddigi et al: Five Year Long Term Results of Endoscopic Dorsal Ramus Rhizotomy and
Anatomic Variations ot the Painful Lumbar Facet Joint, Paper SMISS 2013
Detail of the inflamed
facet joint innervation
Patient in prone position
S U R G I C A L
T E C H N I Q U E
Multiuse RT
Multiuse RT can be used for various diagnostic and therapeutic procedures on the spinal column. It is suitable, amongst other procedures, for periradicular therapy (PRT) and facet joint blocks. Its
components are ideally adapted to various procedures on the spinal
column.
Prior to each procedure on the spine and also to a rhizotomy, extensive clinical diagnostics, MRI and/or CT, complemented with conventional x-ray imaging, need to be carried out. Ultimate certainty in
locating the level of the facet joints generating the pain can be obtained using facet joint infiltration or myelography.
Facet joint infiltration with contrast
medium injection
Access to the facet joint
In the case of a degenerative facet joint syndrome, a minimally invasive infiltration of the affected facet joint can be carried out. Under
X-ray control the patient is administered with a local anesthetic in
order to find out from the patients response, whether or not the
anesthetic has relieved the pain. If this is the case, the conductivity
of the nerve branch causing the discomfort can be interrupted using
a radio frequency device.
Nerve bran
ch
Facet joint denervation with Legato®
probe through the Multiscope
Facet joint denervation with Legato®
probe under endoscopic view
Combo
Multiscope Combo/Ocular
•
•
•
•
•
Ocular
Usable length 125 mm
Outer diameter 5.8 mm
Inner diameter working channel 3.1 mmm
Optic angle 30°
One suction and one irrigation channel 1.4 mm
Endoscopic access through the working tube in a rhizotomy procedure
joimax® RF probes (monopolar and bipolar)
With the joimax® radiofrequency probe chronic, degenerative back pain can be treated accurately. Percutaneous facet joint denervation
(neurolysis of the medial dorsal ramus) has proven to be an effective option of treatment2). Also neck pain after whiplash injury or in degenerative spinal diseases are a rewarding indication for the use of radiofrequency technology. With the denervation of these joints can
be achieved outstanding results.
Legato® monopolar
Single-use probe
Single-use probe
Legato® bipolar
3
S Y S T E M
joimax® Multiuse RT
joimax® HD Endoscopy Tower(s)
The Multiuse RT is a new product that enhances the joimax®
complete system offering in the field of endoscopic facet joint treatment and other pain management of the spine.
The expert solution for spinal surgery and neurosurgery. All devices are optimally matched and designed specifically for sensitive
structures.
Uni Cart Trolley
2410 24“
REF
Description
MUSSTD
complete tray, with container, without Multiscope
MS5830125C
Multiscope Combo
MS5830125O
Multiscope Ocular
Order numbers for individual components are available upon request.
Disposables (sterile):
TDAK0010
Disposable Access Kit 1, basic
PU 10
JMSN18GW
Needle 18G 15 cm + guide wire 40 cm
PU 10
JMSN18GW11
Needle 18G 11 cm + guide wire 30 cm
PU 10
®
JMPP27025
Legato Probe mono, ball tip
PU 5
JMPP27020
Legato® Probe bipo, ball tip
PU 5
Handpieces (reusable with 3.5 m cable):
JBPH352505
Legato® handpiece bipo, cable with plug for Endovapor®
JMPH352503
Legato® handpiece mono, cable with plug for Erbe
JMPH352504
Legato® handpiece mono, cable with plug for Valleylab
Other cables on request.
Optional devices (not part of the complete set):
JSM120
joimax® Endovapor®
JEVD0201
joimax® Endovapor® 2
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PHONE
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FAX
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MAIL
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NET
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PHONE
FAX
MAIL
NET
+1 949 859 3472
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joimax® Multiuse RT · 02_2014 · BROMUDE · Printed on chloride-free bleached paper · Vegetable-based inks were used in the printing process
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