Tolerability and Feasibility of X-ray Guided Non-Invasive Ablation of the Medial Branch Nerve with Focused Ultrasound: Preliminary Proof of Concept in a Pre-clinical Model

• Main Authors: Aginsky, R. (Author), Aubry, J.-F (Author), Chen, J. (Author), Gofeld, M. (Author), Hananel, A. (Author), LeBlang, S. (Author), Perez, J. (Author), Shir, Y. (Author)
• Format: Article
• Language: English
• Published: Elsevier Inc. 2021
• Subjects: Ablation; ablation therapy; adverse event; analgesia; animal; animal experiment; animal model; Animals; anticoagulant agent; antithrombocytic agent; Article; bone metastasis; chronic pain; Chronic Pain; Computed tomography scan; computer assisted surgery; Computerized tomography; controlled study; Facetogenic pain; Feasibility Studies; feasibility study; female; Female; fluoroscopy; Focused ultrasound; high intensity focused ultrasound; High intensity focused ultrasound; High-intensity focused ultrasound; High-Intensity Focused Ultrasound Ablation; innervation; intervertebral disk; joint degeneration; low back pain; male; Male; Mammals; neuralgia; Neuralgia; neurosurgery; Neurosurgical Procedures; nonhuman; nuclear magnetic resonance imaging; pig; prevalence; priority journal; procedures; proof of concept; Proof of concept; Proof of Concept Study; radiofrequency; radiofrequency ablation; Radio-frequency Ablation; Radiofrequency electrodes; sacroiliac joint; sensory nerve; Standard of cares; Surgery, Computer-Assisted; Swine; thalamotomy; Thermal ablation; Tissue; Ultrasonics; United States; X ray; X rays; x-ray computed tomography; x-ray guided non invasive ablation; X-Rays; zygapophyseal joint; Zygapophyseal Joint
• Online Access: View Fulltext in Publisher
• ISBN: 03015629 (ISSN)
• DOI: 10.1016/j.ultrasmedbio.2020.10.019

Four to six million patients a year in the United States suffer from chronic pain caused by facet joint degeneration. Thermal ablation of the affected facet joint's sensory nerve using radiofrequency electrodes is the therapeutic standard of care. High-intensity focused ultrasound (HIFU) is a novel technology enabling image-guided non-invasive thermal ablation of tissue. Six pigs underwent fluoroscopy-guided HIFU of the medial branch nerve and were followed up for 1 wk (two pigs), 1 mo (two pigs) and 3 mo (two pigs). At the end of each follow-up period, the animals were sacrificed, and targeted tissue was excised and evaluated with computed tomography scans as well as by macro- and micropathology. No significant adverse events were recorded during the procedure or follow-up period. All targets were successfully ablated. X-Ray-guided HIFU is a feasible and promising alternative to radiofrequency ablation of the lumbar facet joint sensory nerve. © 2020 The Authors