Endoscopic Facet Denervation
ENDOSCOPIC RHIZOTOMY or MEDIAL BRANCH TRANSECTION is a procedure performed on patients suffering from chronic low back pain caused by inflammation or osteoarthritis of the lumbar facet joints. In people over the age of 40, this is the most common cause of chronic low back pain. Pain is typically worsened by getting up in the morning, after long sitting, or after prolonged standing. Facet joints are true joints on the posterior side of the spine and are innervated by small branches of the spinal nerves, called medial branches. Each facet joint is innervated by the medial branch from the corresponding spinal level and the level below it. As these little nerves do not have any other function than sending information from the joints to the brain, their transection has been a well studied and effective intervention since the 1970's. There
is a the big advantage to a full-endoscopic approach. This is because the appropriate nerves can be identified through direct visualization through the endoscope, and surgical tools or a laser can be used to safely cut the nerve and also strip away some of the overgrown tissue on very arthritic painful joints. The procedure is performed with the patient in the prone position. Local anesthesia with conscious sedation or general anesthesia is possible. A 3/4" skin incision is made. A dilator is then passed under real time X-ray (fluoroscopy) to the area of the spine where the medial branch nerve is found, and a thin tubular working channel is the passed over the dilator which is then removed leaving the working channel in place as a portal for the endoscope to reach the spine. The only incision will be in the skin, and no cutting of deeper tissue or muscle is necessary. This means a very short recovery time! Under direct visualization through the endoscope, the medial branch (which lays on the outside of the spine) at each level is identified and cut with a laser or other surgical tools . This procedure is repeated at each painful joint, most commonly the joint L4/5 and L5/S1 or L3/4 on one side or both.
IS IT EFFECTIVE?
FOR HOW LONG WILL I GET RELIEF?
Normally, two test blocks of the medial branch nerves (medial branch blocks) will have been performed on sessions prior to this procedure. If you experienced a high degree of temporary relief from these medial branch blocks, it is very likely that you will get a close to equal degree of relief from trasection of the medial branch nerves, generally on a long term basis of several years. Sometimes relief may be as long as five or more years. Facet joint arthritis is part of a spectrum of degeneration of the spine, and other pain generators from disc disease, spinal stenosis, or other spinal disorders may or may not arise, but NOT as a result of this procedure.
IS IT SAFE?
This is considered a minimally invasive procedure with very little chance of serious complication, as the nerve and joint are well away from major nerves, vessels, and the spinal cord. Intravenous antibiotics will be
given prior to the procedure to minimize infection risk.
HOW LONG WILL MY RECOVERY BE?
Usually, you will go home about an hour after the procedure is finished. You may be in some discomfortfor several days, but not severe pain. Pain medication will usually be prescribed for a
few days. The onset of relief of your usual pain and stiffness is rapid.