Patient and provider radiation exposure during fluoroscopy guided chemical and thermal neurolysis of genicular nerves: A prospective cohort comparison study

TL;DR

This study compared radiation exposure and procedure times for chemical and thermal neurolysis of genicular nerves, finding no significant differences in radiation exposure but shorter procedure times for chemical neurolysis.

Contribution

The study provides new empirical data on radiation dosimetry and procedure efficiency for two genicular neurolysis techniques in a clinical setting.

Findings

Patient radiation dose and fluoroscopy time were not significantly different between chemical and radiofrequency neurolysis.

Procedure times were shorter for chemical neurolysis compared to radiofrequency neurolysis.

Higher BMI and Kellgren-Lawrence grades were associated with increased patient radiation dosimetry.

Abstract

To evaluate the differences in radiation dosimetry, fluoroscopy time and procedure time between fluoroscopy-guided chemical and thermal genicular neurolysis techniques.

This single-site, open label observational cohort was done at an urban, tertiary medical center pain clinic. Board certified pain medicine physicians with at least 5 years of experience with genicular neurolysis procedures performed or supervised all interventions. Clinical characteristics and procedural details were collected at each procedure. Patients underwent chemical neurolysis using phenol or cooled radiofrequency neurolysis. Radiation dosimetry was the primary outcome and was compared between the between chemical and radiofrequency neurolysis groups.

Thirty-one subjects (15 had chemical and 16 had radiofrequency neurolysis procedures) underwent a total of 43 interventions. Twelve underwent bilateral procedures. Radiation dosimetry per procedure was 1.66 (0.89 to 2.45) Gy-cm2 for chemical and 1.76 (1.08 to 2.28) Gy-cm2 for radiofrequency neurolysis, adjusted mean difference −0.092 (−0.60 to 1.114, P ​= ​0.864) Gy-cm2. Procedure times were shorter for chemical compared to radiofrequency neurolysis procedures, difference 9.2 (95% CI 6.8 to 11.6, P ​< ​0.001) minutes; but no between treatment group differences in fluoroscopy time or interventionalist radiation exposure were observed. Higher BMI and advanced Kellgren-Lawrence grades were associated with increased patient radiation dosimetry.

We found that patient radiation dose, fluoroscopy time, and interventionalist radiation exposure were not different between chemical and radiofrequency neurolysis. Genicular neurolysis was more rapidly performed using chemical as compared to radiofrequency neurolysis. BMI and Kellgren-Lawrence grade, but not procedural factors were associated with greater absorbed radiation doses.

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