Study confirms merits of MRgFUS for facet pain.
It’s always exciting when a new way comes along to manage chronic pain with less medication, invasiveness and risk of complications. Lower back pain from facet joint osteoarthritis that does not respond to physical therapy, exercise, heat/cold applications and over the counter anti-inflammatories is particularly difficult to treat. In the search for relief, patients turn to treatments that involve inserting needles into the very small spaces between the joints (e.g. injections of anesthesia/steroid mix, radiofrequency probes to deaden the nerves). Not only are such treatments often temporarily painful and have the risk of infection, but in about half of cases there is no meaningful pain relief.
It’s no surprise, then, that MRI-guided Focused Ultrasound (MRgFUS) is gaining attention as a noninvasive therapy for facet joint pain. There are no needles and no exposure to radiation (x-ray guided treatments). Because it is done under real-time MRI guidance, diagnostic accuracy and thermal feedback software enable precise nerve deadening with minimal to no risk of complications.
At the 2016 annual meeting of the European Society of Radiology, researchers from the Radiology Department of the Hospital Clinic of Barcelona (affiliated with the University of Barcelona) presented an observational study on the safety and effectiveness of MRgFUS for alleviating facet joint pain in the lower (lumbar) spine.i
Although it was a very small study (only 7 patients) the results were favorable. All of the patients had confirmed facet pain that had no longer responded to conventional approaches for at least 6 months. Each patient underwent MRgFUS, calibrated very precisely to ablate the targeted nerve while sparing a larger nerve that controls specific muscles – in other words, no collateral damage that would affect motion. Response to treatment was measured by three different validated self-report questionnaires on pain and quality of life, and these were administered at 1, 3, 6 and 12 months after treatment.
All 7 patients reported easing of pain. The average pain scale score had dropped by 53.8% at 12 months, and an average 49% improvement in quality of life was reported at the same 12-month evaluation. There were no major complications and all patients tolerated the treatment very well.
The authors of the study acknowledge that more research with larger patient samples is needed. However, they concluded that MRgFUS is “a valid tool and enriches the therapeutic options for chronic back pain caused by facet joint osteoarthritis. This is a new noninvasive technique that potentially prevents complications derived from needle punctures, under real-time thermal and anatomic image control provided by MRI.”
iSquarcia M, Munoz FG, Pomes J, Moreno A et al. Effectiveness and safety of high intensity focused ultrasound guided by magnetic resonance imaging (MRgFUS) in the treatment of osteoarticular lumbar spinal pain originating from the facet joints. Scientific Exhibit poster C-1344. European Society of Radiology Annual Meeting, 2016.
- Facet Pain