49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Ultrasound-Guided High-Intensity Focused Ultrasound Could Improve Neuroablation of the Sacroiliac Joint in a Swine Model

Rahul Chaturvedi, MD1; Evgeny Bulat, MD, MA2; Jason Crowther, MD, PhD3; Amitabh Gulati, MD4

1Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY; 2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA;3Department of Anesthesia & Perioperative Medicine, UMass Chan Medical School and UMass Memorial Health; 4Memorial Sloan Kettering Cancer Center, New York, NY

INTRODUCTION

•Refractory SI joint pain can be treated with radiofrequency ablation, which can require 12 probes, and is time-consuming1

•High-intensity frequency ultrasound (HIFU) could be a less invasive, more efficient and resource conscious option

•MRI, CT, and fluoroscopy have all been explored for HIFU image guidance for pain procedures2,3

•Ultrasound-guided HIFU (USgHIFU) would allow for more time and resource-sensitive neuroablation and also would minimize ionizing radiation

MATERIALS AND METHODS

•Prospective technology safety and efficacy study

•MSKCC Animal Care & Use Committee-approved study (Protocol #21-12-009)

•Two healthy pigs underwent USgHIFU after general anesthesia

•Sonication performed via a USgHIFU prototype developed by FUSMobile, Inc. (Alpharetta, GA)

•18 primary sonication targets (area between superior articulating process of sacrum and S3 for each pig).

•Following emergence, each pig was monitored for 72 hours for signs of pain and gait abnormalities

RESULTS

•58% (21/36) of specimens suggested successful lesioning

•Of the successful lesions:

•52% (11/21) included nerve lesions

•95% (20/21) included muscle lesions

•86% (18/21) included periosteum lesions

•95% (20/21) included bony lesions

•Spinal canal lesion

•28% (10/36) included spinal canal lesion

•19% (7/36) included injury epidural adipose

•8% (3/36) included injury nerve roots

DISCUSSION

•USgHIFU could potentially be utilized to target sacral nerves

•Potential benefits include decreasing cost, time for procedures, resource utilization, and patient discomfort

•Future larger scale studies need to be conducted as operators become more experienced with the procedural components in order to ensure safety of the technology given the spinal canal ablation zones identified, and to assess for improved outcomes for those with refractory pain

REFERENCES

1Lowe M, Okunlola O, Raza S, et al. Radiofrequency Ablation as an Effective Long-Term Treatment for Chronic Sacroiliac Joint Pain: A Systematic Review of Randomized Controlled Trials. Cureus. 2022;14(6):e26327. Published 2022 Jun 25. doi:10.7759/cureus.26327

2Wijlemans JW, Bartels LW, Deckers R, et al. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation of liver tumours. Cancer Imaging. 2012;12(2):387-394. Published 2012 Sep 28. doi:10.1102/1470-7330.2012.9038

3Perez J, Gofeld M, Leblang S, Hananel A, Aginsky R, Chen J, Aubry JF, Shir Y. Fluoroscopy-Guided High-Intensity Focused Ultrasound Neurotomy of the Lumbar Zygapophyseal Joints: A Clinical Pilot Study. Pain Med. 2022 Jan 3;23(1):67-75.

49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

ULTRASOUND-GUIDED HIGH-INTENSITY FOCUSED ULTRASOUND COULD IMPROVE NEUROABLATION OF THE SACROILIAC JOINT IN A SWINE MODEL

Poster Presenter

Authors

Affiliations

Part of Topic