Abstract
PURPOSE: To evaluate the differences in radiation dosimetry, fluoroscopy time and procedure time between fluoroscopy-guided chemical and thermal genicular neurolysis techniques. METHODS: 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. RESULTS: 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-cm(2) for chemical and 1.76 (1.08 to 2.28) Gy-cm(2) for radiofrequency neurolysis, adjusted mean difference -0.092 (-0.60 to 1.114, P = 0.864) Gy-cm(2). 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. CONCLUSIONS: 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.