1. Facet Denervation 1993-2008 Jalal Jalal Shokouhi-MD Interventional radiologist, ISR, Tehran,Iran M.H. Herischi-MD Orthopedic surgeon, Baku,Republic Azerbayjan A.Ali Norosi-MD Neurosureon, Leopold clinic,Munich,Germany H.R. Mirbagheri-MD Orthopedic surgeon, London, Uk Jalaljalalshokouhi@hotmail/Gmail.com Facet Denervation 1993-2008

2. F acet P ain: Young adult “Microtraumatic” After 60 “Degenerative”

3. P athophysiology: Impingement, trauma of dorsal sensory root or circumflex nerve Pain in rest and early morning Hypertrophic phenomenon o Compensatory to trauma o Degenerative hypertrophic o Canal stenosis even myelopathy

9. Microtherapy  2800 patient 1993 to 2008  2750 facet therapy  Facet syndrome  Companion therapy (Adjunctive therapy with PRT)

10. 1-2 times FT,PRT before surgery reduce rate of failed back surgery or syndrome

11. In pure facet syndrome for one level, treatment should be done in 3 levels: related level, upper level and also lower level.

12. M aterials and M ethods:  Needle  6cm,21G Angiocat Core  10cm,21G Coaxial S.G  10cm,21-22G L.P, Cook  Drugs  6-10cc Lidocain 1%, Marcain 0.5% or Bupvicain 0.5%, Scandicain 1%  Triamecinolon Acetonid or Depomedrol 20-40mg  Ethanol 65-90% 2-3cc  All CT guided  All with back school after second injection First injection may increased irritation and pain  4 to 8 times treatments are need (every 3 weeks)

22. R esults R esults: 85% pain-free after 2-4 times treatments 98% pain-free after 4-8 times treatments All back to work 2% of patients need to repeat treatment *All treated facets were in lumbar region **88% facet syndromes were on L 4 -L 5 level

23. TH A NK Y OU F O R YO U R A T TE N TI O N