Menu

Endoscopic Rhizotomy

Endoscopic Rhizotomy

An Endoscopic Rhizotomy is the least invasive technique that can treat chronic low back pain originating from spinal arthritis or in other words facet arthritis. This technique allows direct visualization of the medial branch nerves that supplies the arthritic facet joints in the back of the spine. This procedure may also be called a facet joint denervation.

What is a minimally invasive endoscopic rhizotomy surgery?

An endoscopic rhizotomy is the least invasive surgery that allows direct visualization of the medial branch nerves that supply the arthritic facet joints in the back of the spine. This procedure may also be called a facet joint denervation.

Medial branch nerves are very small nerves that innervate the facet joints of the spine. Facet joints are the joints connecting the different vertebra of the spine to each other. The joints are present on both sides of the spine from the neck to the lower back. When facet joint become arthritic, it can irritated and compressed these nerves and causing debilitating chronic low back pain. These nerves are not the nerves that control your bowel, bladder and/or sensation, movement in your legs.

The goal of the surgery is to identify these painful nerves by using endoscope and “snip” them using special equipment to cure these painful nerves. Again, these nerves are not the nerves that control your bowel, bladder and/or sensation, movement in your legs; thus very minimal to none consequences following the surgery.

What is the different between a radiofrequency ablation and an endoscopic rhizotomy?

A radiofrequency ablation is a procedure for back pain where pain specialists use special needles and electrical current to turn off the nerves and their ability to transmit pain signals. The procedure in a way is a “guessing’ at best as they do not identify or “seeing” the nerves. Usually provides only 6-9 months of relief. Most of the time the nerve will grow back and the pain returns.

The endoscopic rhizotomy is to identified these nerves and “snip” or making the gap so the nerves are less likely to grow back; thus giving you a long term relief.

What are some of the benefits of an endoscopic rhizotomy surgery?

  • Minimally invasive procedure
  • Small incision and minimal scar tissue
  • Outpatient procedure
  • Long term relief of back pain
  • Short recovery time
  • Very minimal blood loss
  • Spinal mobility is maintained

When is an endoscopic rhizotomy recommended?

  • The patient has lower back pain longer than 6 weeks with no response to conservative treatments
  • Patient has restricted range of movement in the lumbar spine, particularly when bending backwards
  • Established diagnosis and confirmation that the pain is from the facet arthritis. Blocking the facet joint or medial branch nerve can confirm that lower back pain is caused by the facet joint

What are the indications for an endoscopic rhizotomy?

A rhizotomy is indicated if the diagnostic *medial branch block (MBB) procedure is successful in confirming back pain is originating from the facet joints. A medial branch block (MBB) is an injection of a local anesthetic at the medial branch nerve to temporarily block the pain signal carried from the facet joints to the brain. It is a diagnostic tool and provides only temporary relief from pain and is used in diagnosing the cause of your back pain.

What are the details of an endoscopic rhizotomy?

Usually done under monitered anesthesia care, meaning you’re awake and responsive, but comfortable throughout the procedure. Endoscopic rhizotomy surgery is an outpatient surgery and is done under conscious sedation. A small incision is made in the surgical area and a small tube with a camera is inserted into the spine, guided by fluoroscopic X-ray to place the camera in the correct position. The camera allows for direct visualization to identify the medial branch nerves. After identifying the nerve, a small section is cut from the nerve, preventing any regrowth in the future.

What to expect after the procedure?

While this is an outpatient surgery, we do recommend resting initially and then gradually increasing activity levels. You may also be advised to wear a back brace for added support during the healing process.