Cryoneurolysis in facet joint syndrome management

To assess the clinical usefulness of facet joint cryoneurolysis in patients suffering from back pain of facet origin. Twenty nine patients suffering from chronic low back pain > 3 months were consecutively included in this single centre between 2015 and 2018 and 45 cryoneurolysis were performed. The decision to perform cryoneurolysis was made by the operator and based on multiple criteria : clinical history of pain in favour of facet joint pain, imaging data and a positive response to at least one medial block test. The following criteria were noted prior to the procedure : pain location, mean duration of pain prior to denervation, laterality of the pain, and intensity (visual analogic scale (VAS) score 1–10). All cryoneurolysis were performed ambulatory under local anaesthesia and computed tomography (CT) guidance. Sensory and motor stimulation were performed at each treated level and correlated to pain outcome. Follow-up clinical examination was performed at 1, 3, 6 and 12 months after procedure and clinical effectiveness was defined as a 50 % pain decrease on VAS scores. A total of 29 patients with a mean age of 60, y.o were included in our study, including 11 men and 18 women. Prior to the procedure, mean VAS score was 7,31/10. A total of 45 procedures were performed and an average of 2 cycles were performed per localisation and per intervention. Thirty out of the 45 procedures performed were considered a success, that is, a global success rate of 66 % percent with a mean pain relief period of 6,8 months. There was no statistical difference in efficacy depending on the sensory stimulation threshold, no correlation was found between threshold evolution during the procedure and procedure success. Cryoneurolysis of the medial branch is effective in patient presenting with facet joint pain in 66 % of cases. It should be considered as an alternate tool to alleviate facet joint mediated pain, in accurately selected patients.