Back Pain

Background

Outside Approval SquareFacet arthritis affects the joints that connect the vertebrae and provide stability and flexibility in the spine. It is the source of pain in 15% to 45% of patients suffering from chronic back pain.

Facet arthritis usually develops from normal wear and tear over the lifetime. Factors that increase the risk for facet arthritis include older age, obesity, female gender, trauma to the bones, and work or sports injuries.

Current Treatment

Treatment options for facet arthritis include oral medications, injections, and radiofrequency ablation to relieve pain.  Surgery can be performed in severe cases.

Clinical Trials Square

Focused Ultrasound Treatment

Focused ultrasound may offer a noninvasive, radiation-free method of facet rhizotomy. Using MRI or ultrasound imaging, the physician directs ultrasound beams through the patient’s skin to the sensory nerve along the affected facet joint. This heats and destroys the nerve, thereby blocking its ability to transmit pain signals. As a noninvasive form of facet rhizotomy, focused ultrasound may offer benefits including:

  • no needles (anticoagulation thus not an issue)
  • no ionizing radiation
  • can treat several affected facet joints in one session
  • real-time anatomic and thermal monitoring, which reduces the risk for complications
  • shorter recovery time.

Clinical Trials

A phase I observational pilot study of 18 patients with lumbar facet disease was performed at St. Mary's Hospital in London, where focused ultrasound reduced pain and improved quality of life with few side effects. The results of the pilot study were published in 2012. Several patients with facet arthritis pain also have been treated with focused ultrasound at the Kochi Medical University Hospital in Japan. There are other sites in Europe now performing this procedure regularly with good outcomes including patient improvement and few side effects.

A study is underway at Stanford University in California to determine the safety and efficacy of focused ultrasound for lumbar back pain. If you are interested in taking part, please contact Kara Richardson (650.561.5237 or ). 

Research and Treatment Sites

MR Therapy Centre at St. Mary’s Hospital, London, United Kingdom
Contact information:
Dr. Gedroyc Wladyslaw
+44 (0) 203 312 7605


Jaslok Hospital and Research Center, Mumbai, India
Contact information:
Dr. Shrinivas B. Desai
+91 22 6657 3368


www.jaslokhospital.net

Concept Medicare (India) Pvt Ltd
Contact information:
Mr. S. Pattu, Chairman
Noble Marine Towers No. 62
Mount Road, Guindy
Chennai, 600 032
Phone: 044 900 2400


www.conceptmedicare.in

Kochi Medical University Hospital, Kochi, Japan
Contact information:
Dr. Motohiro Kawasaki (Orthopaedics)
Phone: 088 880 2386


Future Medical Imaging Group, Melbourne, Australia
Contact information:
Dr. Andrew Dobrotwir Siobhan
Tuohy
+61 2 9818 7833

Stanford University, California, US
Dr. Pejiman Ghanouni (Study PI)
Contact information:
Kara Richardson
Phone: 650.561.5237
  

MRgFUS Center Frankfurt, Germany
Triamedis Ärztehaus
Contact Information: Professor Dr. Markus Düx
Phone: 0049-69-874030100
www.mrgfus-zentrum-frankfurt.de

Regulatory Approval and Reimbursement

The ExAblate system manufactured by InSightec is approved in Europe for treatment of facet arthritis pain. At present, focused ultrasound treatment of facet arthritis pain is not universally reimbursed by medical insurers.

Notable Papers

Krug R, Do L, Rieke V, Wilson MW, Saeed M. Evaluation of MRI protocols for the assessment of lumbar facet joints after MR-guided focused ultrasound treatment. J Ther Ultrasound. 2016 Apr 6;4:14. doi: 10.1186/s40349-016-0057-8. eCollection 2016.

Filippiadis DK, Kelekis A. A review of percutaneous techniques for low back pain and neuralgia: current trends in epidural infiltrations, intervertebral disk and facet joint therapies. Br J Radiol. 2016;89(1057):20150357. doi: 10.1259/bjr.20150357. Epub 2015 Oct 14.

Weeks EM, Platt MW, Gedroyc W. MRI-guided focused ultrasound (MRgFUS) to treat facet joint osteoarthritis low back pain-case series of an innovative new technique. Eur Radiol. 2012 Dec;22(12):2822-35. Epub 2012 Aug 31.

Dick EA, Gedroyc WM. ExAblate magnetic resonance-guided focused ultrasound system in multiple body applications. Expert Rev Med Devices 2010 Sep;7(5):589-97.

Click here for additional references from PubMed.

     

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