Magnetic resonance-guided focused ultrasound treatment of facet joint pain: summary of preclinical phase

Journal of Therapeutic Ultrasound

Israel Caspi¹  Itay Goor-Aryeh²  Yael Inbar⁴  Arik Hanannel⁵  Osnat Dogadkin³  Lilach Shay³  Zion Zibly⁶  Sagi Harnof³ 

[1] Department of Orthopedic Surgery, Sheba Medical Center, Ramat Gan 52621, Israel;Department of Anesthesiology, Sheba Medical Center, Ramat Gan 52621, Israel;Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel;Department of Radiology, Sheba Medical Center, Ramat Gan 52621, Israel;The Focus Ultrasound Foundation, Charlottesville, VA 22903, USA;Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, OH 43210, USA

关键词: Pain palliation;    MRgFUS;    Facet joints;    Chronic back pain;   

Others  :  801106
DOI  :  10.1186/2050-5736-2-9

 received in 2013-06-13, accepted in 2013-10-08,  发布年份 2014

【 摘 要 】

Study design

A phantom experiment, two thermocouple experiments, three in vivo pig experiments, and a simulated treatment on a healthy human volunteer were conducted to test the feasibility, safety, and efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) for treating facet joint pain.

Objective

The goal of the current study was to develop a novel method for accurate and safe noninvasive facet joint ablation using MRgFUS.

Summary of background data

Facet joints are a common source of chronic back pain. Direct facet joint interventions include medial branch nerve ablation and intra-articular injections, which are widely used, but limited in the short and long term. MRgFUS is a breakthrough technology that enables accurate delivery of high-intensity focused ultrasound energy to create a localized temperature rise for tissue ablation, using MR guidance for treatment planning and real-time feedback.

Methods

We validated the feasibility, safety, and efficacy of MRgFUS for facet joint ablation using the ExAblate 2000® System (InSightec Ltd., Tirat Carmel, Israel) and confirmed the system's ability to ablate the edge of the facet joint and all terminal nerves innervating the joint. A phantom experiment, two thermocouple experiments, three in vivo pig experiments, and a simulated treatment on a healthy human volunteer were conducted.

Results

The experiments showed that targeting the facet joint with energies of 150–450 J provides controlled and accurate heating at the facet joint edge without penetration to the vertebral body, spinal canal, or root foramina. Treating with reduced diameter of the acoustic beam is recommended since a narrower beam improves access to the targeted areas.

Conclusions

MRgFUS can safely and effectively target and ablate the facet joint. These results are highly significant, given that this is the first study to demonstrate the potential of MRgFUS to treat facet joint pain.

【 授权许可】

   
2014 Harnof et al.; licensee BioMed Central Ltd.

【 图 表 】

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