Ultrasound-Guided Versus C-Arm Fluoroscopy Controlled Radiofrequency Ablation of the Cervical Facets

Background: Cervical Facet radiofrequency ablation is indicated for patient with chronic neck pain. It is generally carried out under fluoroscopic guidance. The long term exposure of the surgeon to radiation may cause serious side effects. Ultrasonography-guided facet ablation has recently been attempted. Objective: Our aim is to compare between ultrasonographic and fluoroscopic imaged guided techniques for non-pulsed radiofrequency ablation of the facets of the cervical spine. Patients and Methods: We followed forty patients who had cervical pain due to facet arthropathy. They were diagnosed as having cervical spondylosis and operated from January 2012 to October 2015 in Departments of Neurosurgery and Radiology in Suez Canal University Hospitals. Patients were divided into two groups: Ultrasound group and fluoroscopy group. Results: We studied 123 levels of the cervical facet joint which underwent radiofrequency ablations in forty patients. Sixty three facets were ablated using fluoroscopy, while sixty one facets were ablated under ultrasonographic guidance. The demographic characteristics between the two groups were not statistically different. The mean execution time per facet joint was 14 minutes for fluoroscopic guidance compared to 10 minutes for ultrasonographic guidance. Clinical outcomes in both groups showed no significant difference. Ultrasonographic guidance showed less execution time and no radiation exposure. Conclusion: The ultrasound-guided facet joint ablation in the cervical spine is accurate, feasible, and bears minimal risk. It results in a significant pain reduction, not different from fluoroscopic-guided ablations. Additionally a reduction of execution time, radiation dose and resources is highly evident.