Poster - RFT Listhesis

Radiofrequency Neurotomy for the Treatment of Low Back Pain
in Patients with Degenerative Spondylolisthesis
S. Klessinger
nova clinic, Department of Neurosurgery, 88400 Biberach, Germany
klessinger@nova-clinic.de
Introduction:
Results:
Examples and Limits:
Degenerative spondylolisthesis is one of the major causes
for low back pain. Morphological abnormalities of the
zygapophysial joints are a predisposing factor in the
development of degenerative spondylolisthesis. Therefore
radiofrequency neurotomy seems a rational therapy.
Therefore the objective of this study was to determine if
radiofrequency neurotomy is effective for patients with low
back pain and degenerative spondylolisthesis.
During a time period of 3 years 1490 patients were treated
with lumbar radiofrequency neurotomy, of them 67 patients
with degenerative spondylolisthesis.
MRI of a patient with a degenerative spondylolisthesis L4/5
but also a severe spinal canal stenosis and a zygapophysial
joint osteoarthritis.
It is comprehensible that radiofrequency neurotomy can be of
limited effectiveness in a case
like this.
36
16
13
5
3
40-49
Examples of zygapophysial joint alterations
Material & Methods:
Review of charts of all patients with degenerative
spondylolisthesis who underwent treatment with
radiofrequency neurotomy during a time period of 3 years.
Only patients with an MRI confirming the diagnosis were
included. Patients with a lumbar spine operation in history
and patients with neurological deficits were excluded.
Patients were treated with lumbar radiofrequency
neurotomy. Positive treatment response was defined for at
least 50% reduction of pain or sufficiently satisfaction of the
patient. A radiofrequency neurotomy was only performed
after positive diagnostic medial branch blocks.
50-59
60-69
70-79
80-89
42
38
Conclusions:
25
21
8
Meyerding 1
Meyerding 2
3/4
4/5
A significant pain reduction was achieved in 64.2 % of the
patients. The level L4/5 was found statistically significantly
more often in the non-responder group (P = 0,039).
64.2 %
43
35.8 %
24
Example of a radiofrequency neurotomy. A: Oblique radiograph. Position of
the electrode beside the L5 superior articular process. B: Oblique
radiograph of the same patient. Position of the electrode beside the S1
superior articular process.
5/1
positive
negative
Zygapophysial joints are a possible source of pain in patients
with spondylolisthesis. Radiofrequency neurotomy is a
rational specific non-operative therapy in addition to other
non-operative therapy methods with a success rate of 64.2
%. This is the first study to determine the effect of
radiofrequency neurotomy in patients with degenerative
spondylolisthesis.
Spondylolytic Spondylolisthesis
The etiology and the mechanisms of pain are different in
patients with spondylolytic spondylolisthesis.
Patients are younger, there are
less degenerative changes and
seldom a spinal stenosis.
In the group of patients with
spondylolysis all defects were
found in level L5/S1 (Meyerding I
and II). The success rate was
even higher with 81.3 % positive
effect of radiofrequency neurotomy.
More research has to be done to
analyse these data.