Endoscopic Rhizotomy Overview
The Endoscopic Rhizotomy is a least invasive outpatient procedure that helps patients suffering from chronic back pain and muscle spasms. When patients lean forward they are fine but leaning backwards or standing for long periods causes significant pain and muscle spasms. Patients who receive temporary relief from facet injections, medial branch blocks or percutaneous rhizotomies/RFA are good candidates for endoscopic rhizotomy.
This procedure allows the physician to place a small cannula and endoscope 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. “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.”*
The advantage of the endoscopic rhizotomy is that it is often used when other surgeons have recommended no treatment at all, or a 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 Rhizotomy treat?
- Facet joint syndrome
- Facet related arthritis
- Chronic low back pain
- Back spasms related to the facet joint
- Failed back surgery
When is an Endoscopic Rhizotomy Recommended?
- Primarily low back pain for more than 6 weeks
- Palpation of low back contributes to 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 Rhizotomy vs. Percutaneous Radiofrequency Ablation?
- 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.
How is the procedure performed?
Under local anesthesia and x-ray fluoroscopy, a needle, guidewire and blunt dilator are placed through a less than ½ inch skin incision through the muscle of the back, targeting the facet joint or the transverse process. (bone extending from the vertebral body)
A 7mm metal tube is placed over the dilator to create access to the transverse process bone where the medial branch nerve is located. An innovative working channel endoscope is coupled with an HD video camera to enhance visualization for the physician. Through the endoscope, small specially designed microscopic instruments are sent down the hollow center of the endoscope to ablate the medial branch nerve, limiting your body’s ability to feel pain from the facet joints. Once the nerve is ablated, the metal tube is extracted.
The procedure takes about an hour on average. You will likely feel minimal pain or discomfort. The incision is secured with one stitch and bandage. Post-operative, patients usually recover for a few hours and then go home.
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