CyberKnife rhizotomy for facetogenic back pain: a pilot study

Area of Science:

• Neurosurgery
• Pain Management
• Radiation Oncology

Background:

• Facetogenic back pain is often treated with radiofrequency ablation or facet joint injections, providing temporary relief.
• Refractory cases necessitate exploring more durable and less invasive treatment options.

Purpose of the Study:

• To evaluate the efficacy and safety of CyberKnife radiosurgery for denervating facet joints in patients with facetogenic back pain.
• To assess the potential for a more thorough and durable antinociceptive rhizotomy compared to existing methods.

Main Methods:

• Five patients with refractory facetogenic back pain and positive PET findings underwent single-session CyberKnife radiosurgery targeting the facet joints.
• A marginal prescription dose of 40 Gy was administered, with maximal doses up to 60 Gy.

Main Results:

• Three out of five patients experienced pain improvement within one month, with durable responses lasting up to 16 months.
• Two patients showed no change in pain levels, and no acute or late-onset toxicity was reported.
• Median follow-up was 9.8 months, with a mean planning target volume of 1.7 cm³.

Conclusions:

• CyberKnife radiosurgery appears to be a safe and effective non-invasive alternative for managing facetogenic back pain.
• Further studies with larger patient cohorts and long-term follow-up are needed to confirm the durability of pain relief compared to radiofrequency ablation.