Endoscopic Facet Rhizotomy

Endoscopic Surgery Overview Endoscopic Discectomy Endoscopic Facet Rhizotomy Cervical Endoscopic Rhizotomy Endoscopic Interlaminer Discectomy Endoscopic Foraminalplasty

What Is An Endoscopic Facet Rhizotomy?

The Endoscopic Rhizotomy is the least invasive outpatient procedure that effectively provides up to 5 years of pain relief for patients suffering from chronic low back pain and muscle spasms related to facet joint disease. When patients lean forward they are fine but leaning backward or standing for long periods causes significant low back pain. Patients suffering from low back pain will most likely see a pain management specialist, and receive facet injections, medial branch blocks or percutaneous radiofrequency rhizotomies (RFA) to relieve the pain. Patient’s results for an RFA is usually temporary, lasting about six to twelve months.  If the pain comes back or ideal long term pain relief was not achieved with the RFA, these patients are usually a good candidate for endoscopic rhizotomy treatment.

Endoscopic rhizotomy allows the spine surgeon to place a small cannula and an endoscope attached to an HD camera, inside the patients back and target visually the medial branch nerve.  A radiofrequency probe is used through the endoscope to ablate the medial branch nerve.  Because the endoscope allows Dr. Rodriguez to see the medial branch nerves that cause low back pain, he can ablate and sever these nerves with certainty.  Also, the endoscopic rhizotomy surgery provides much longer pain relief (up to 5 years) to his patients than the tradition pain management RFA.  This procedure in Dr. Rodriguez’s experience has spared many patients of more invasive spine surgery such as a spinal fusion.  His patients have been very satisfied with the results and typically go back to work or an active lifestyle in a few weeks.

“Endoscopic lumbar medial branch rhizotomy is safe, effective, and provides long-term benefit up to 5 years post-procedure. The endoscopic approach affords clinically superior longevity when compared to published results of radiofrequency ablation.”*

Benefits Of Endoscopic Facet Rhizotomy Procedure:

The advantage of the endoscopic rhizotomy is that it is often used when other surgeons have recommended no treatment at all or spinal fusion for the back. The procedure is less invasive and a great alternative for patients suffering from debilitating back pain and spasms.

  • High success rates, 90% or above
  • Utilizes an HD camera coupled to an endoscope which provides the physician a superior view to that of traditional surgical techniques
  • No spinal fusion is necessary thus preserving the spinal column and the disc
  • Less than ½ inch incision minimizes potential skin scarring
  • No muscle or tissue tearing thus less scar tissue and preserve spinal mobility
  • No significant blood loss
  • Conscious sedation reduces the risk associated with general anesthesia
  • Less post-operative pain and need for narcotic medicines
  • Less recovery time needed
  • Return to work sooner

What Conditions Does Endoscopic Facet Rhizotomy Treat?

When Is An Endoscopic Facet Rhizotomy Recommended?

Patients suffering from low back pain should consider an endoscopic rhizotomy before ever considering major spine surgery.  Also, if you fail to get adequate long term relief from pain management radiofrequency ablation procedures, you may benefit from an endoscopic rhizotomy.

  • Primarily low back pain for more than 6 weeks
  • Palpation of low back contributes to pain and back spasm
  • Greater than 50% relief from medial branch block
  • Symptoms return from previous percutaneous rhizotomy or failed rhizotomy

What Are the Advantages Of Endoscopic Facet Rhizotomy vs. Percutaneous Radiofrequency Ablation?

When patients experience low back pain they typically will end up seeing a pain management specialist to have a medial branch nerve or facet joint injections to pinpoint what is causing the back pain.  If the medial branch nerve injection provides at least 50% reduction in low back pain, they are usually offered a percutaneous radiofrequency ablation.  However, the results for these pain procedures are short term typically less than a year.  The nerves that were partially ablated will usually regenerate and the pain will return.  Unlike the pain management procedure, endoscopic rhizotomy uses a 1/2 inch incision and places an HD endoscope connected to an HD camera and monitor, on the facet or bone where the small nerve exists in the spine.  The surgeon can identify with certainty the medial branch nerve and under direct visualization ablate and sever this nerve.  The results are very favorable with patients.  About 90% of patients achieve back pain relief for up to 5 years.

  • Long-term relief (3-5 years)*
  • Many patients only need one endoscopic procedure versus many percutaneous rhizotomies
  • With endoscopic rhizotomy, the physician can see endoscopically the nerves that cause the back pain and with certainty ablate them.
  • Quick 2-week recovery

 

Surgeon ablating the dorsal ramus medial branch nerve under direct observation with an endoscope.

 

How Is The Endoscopic Facet Rhizotomy Surgery Performed?

The patient is brought to the operating room and is administered with a local anesthetic and conscious and intravenous sedation. Our surgeon, Dr. Rodriguez then marks the surgical facet joint transverse process (bone extending from the vertebral body) targets on the skin level with fluoroscopic guidance (C-Arm X-Ray).  A small incision (about 7 mm) is made on the skin and a small dilator is inserted down the target nerves with a small metal cannula (1/2 inch) inserted over the dilator and then the dilator is taken out.  The endoscope is then placed through the cannula and the small medial branches nerves are identified.

Next, an innovative working channel endoscope is coupled with an HD video camera to enhance visualization for the physician. Through the endoscope, a small radiofrequency probe is sent down the hollow center of the endoscope to ablate and sever the medial branch nerve. Severing this small nerve disconnects the pain signal limiting your body’s ability to feel pain from the facet joints.  Finally, the cannula is removed, the incision is closed with one stitch.  The process is repeated at each facet joint level on one side or both sides of your lower back, and the endoscopic facet rhizotomy is complete. The 1/2 inch incision is secured with one stitch and bandage. The endoscopic rhizotomy procedure takes about an hour on average.

 

 

Dr. Rodriguez performing an endoscopic rhizotomy

 

How Long Is The Recovery After An Endoscopic Facet Rhizotomy, And How Soon Can You Return To Work?

You will likely feel minimal pain or discomfort.  After a very short recovery, you are encouraged to walk around and leave the surgical center, with a companion, the same day. The followup appointment is usually scheduled the next day or within a week.  If traveling to have surgery with us from out-of-state, followup appointment could be the next day after surgery and if all is well you can be cleared to travel home that day of the next.

Recovery depends on how well you and your body responds to the procedure. Many patients will feel better immediately after surgery.  Some patient can go back to sedentary work within a week.  Be careful to listen and comply with your physician’s post-operative instructions. Although you may feel better it is best to not do any heavy lifting at all until cleared by your physician.

* Five Year Long-Term Results of Endoscopic Dorsal Ramus Rhizotomy and Anatomic Variations of the Painful Lumbar Facet Joint; Farhan Siddiqi, MD, Presented at 2013 SMISS Annual Conference