Endoscopic Rhizotomy

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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 backward or standing for long periods causes significant pain and/or muscle spasms. Patients suffering from 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 pain relief was not achieved with the RFA are patients are usually a good candidate 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.”*

Benefits:

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?

When is an Endoscopic Rhizotomy Recommended?

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

  • 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?

When patients experience low back pain they typically will end up seeing a pain management specialist to have a medical 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 is 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 monitor,  on the facet or bone where the small nerve exist 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.  In fact 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

How is the procedure performed?

Under local or conscious IV sedation, and x-ray fluoroscopy guidance, 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)

endoscopy2

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, 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. Once the nerve is ablated, the metal tube is extracted.

The endoscopic rhizotomy 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