Cervical Endoscopic Rhizotomy

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A cervical endoscopic rhizotomy is a least invasive surgery performed by a spine surgeon that allows direct visualization of the nerves to painful facet joints of your neck.  This surgery, through a ½ inch incision, using an HD camera attached to an endoscope, targets small nerves, called the dorsal medial branches, that carry pain signals from your neck and shoulders to your brain. In this surgery, a radiofrequency probe is placed through the endoscope to directly ablate and remove these dorsal ramus medial branch facet nerves to interrupt the pain signal and relieve the perception of neck pain.

The dorsal ramus medial branch facet nerves do not control any muscle functionality in your neck and shoulders.  Therefore, the cervical endoscopic rhizotomy has no negative impact on your ability to function after surgery. This minor surgery may even spare or delay significant spinal fusion surgery.


Who Is A Good Candidate For A Cervical Endoscopic Rhizotomy?

Patients suffering from neck and shoulder pain, resulting from inflammation, degeneration, or arthritis of the cervical facet joints, which have failed conservative care, may greatly benefit.  If a patient gets 50% or more relief from a cervical medial branch block injection, this confirms that the facet joint is causing a significant portion of the pain and that the patient will get good to excellent pain relief results from the cervical endoscopic rhizotomy.  


What Happens During A Cervical Endoscopic Rhizotomy?

The cervical endoscopic rhizotomy is performed at a surgery center or a hospital.  The procedure is least invasive, outpatient, and takes about 1 hour. Patients undergoing surgery can tolerate the procedure well with conscious IV sedation or elect to have general anesthesia. Using real-time X-ray called fluoroscopy, the doctor makes a ½ inch skin incision and guides a small metal dilator to the facet joint over facet dorsal medial branch nerves.  Through an endoscope attached to an HD camera, the surgeon places a radiofrequency probe through the scope to ablate the nerves thus disconnecting the pain signal from your neck to your brain.

The critical difference between this surgery and percutaneous radiofrequency ablation is that the direct visualization by which the surgeon sees the nerve with the HD camera versus pain management using only X-ray.  Seeing the nerves and ablated them with an HD camera dramatically improves the outcomes and longevity of the pain relief the patient receives.


What Should You Expect After A Cervical Endoscopic Rhizotomy?

It is normal for some patients to experience soreness around the skin incision site for a few days.  Physical activities should be avoided for about two to six weeks after surgery. Routine work and physical activities can be resumed as early as two weeks.  Pain relief from the cervical endoscopic rhizotomy typically begins in the first few weeks after surgery.