Facet joint denervation in the treatment of patients with degenerative deformities of the lumbar spine.

Abstract

Purpose. Analysis of the results of surgical treatment of patients with degenerative deformities of the lumbar spine operated using percutaneous and endoscopic denervation techniques. Methods. Design: a retrospective monocentre cohort study. Study group - 58 patients (m/f: 16/42). Median age 64 (60-69) years, minimum follow-up period - 2 years. In 28 cases endoscopic denervation of the lumbar facet joints at the apex of the deformity on both sides was performed (group A), in 30 cases percutaneous radiofrequency denervation in the appropriate volume was performed (group В). The effectiveness of the performed treatment was evaluated on the basis of the dynamics of pain syndrome (VAS), patients' quality of life (ODI), as well as the frequency of complications and repeated surgical interventions. Results. The groups were comparable in terms of sex, age, body mass index, deformity size and pain level (p 0.05). Mean operative duration and radiation exposure were significantly higher with endoscopic intervention (p 0.001). The endoscopic denervation group showed an earlier reduction in back pain syndrome compared to the percutaneous intervention group (p 0.001). No reduction of pain syndrome was noted in 8 (26.7%) patients after percutaneous denervation. Repeated denervation was performed during the two-year follow-up period in 18 patients (60%) of the percutaneous intervention group and in 2 patients (7.1%) of the endoscopic treatment group (p 0.001). The analysis of the factors associated with the efficacy of percutaneous denervation showed the significance of the magnitude of deformation in the frontal plane. Thus, the efficiency of the performed percutaneous treatment decreased at the deformity value of 30° and more with a sensitivity of 77% and specificity of 67%. Conclusion. A more pronounced decrease in the intensity of back pain syndrome with preservation of the effect during the whole period of follow-up was noted in patients after endoscopic denervation. According to our data, the low efficacy of percutaneous denervation is due to the use of this technique in patients with severe deformity of the lumbar spine.