Endoscopic rhizotomy is a minimally invasive endoscopic surgery that allows direct visualization of the medial branch nerve that supplies the facet joints in the back of the spine. The surgery takes the percutaneous RF facet denervation procedure an important step further by providing direct endoscopic visualization of the posterior spinal anatomy and nerves. An incision that is less than a quarter of an inch is made, and a camera is inserted in the spine. By cutting a section of the medial branch nerve, the pain signal is interrupted. This surgery can be performed on the cervical, thoracic, and lumbar spine. It can also be performed on the sacroiliac joint for sacroiliac joint disease.
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.
Radiofrequency Rhizotomy is indicated if a diagnostic procedure called medial branch block is successful in confirming the patient’s back pain is originating from the facet joints. For the sacroiliac joint, a successful sacroiliac joint injection is needed.
Medical branch block is an injection of a local anesthetic directly near 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. It is used to assist your physician in diagnosing the cause of your back pain.
After the medial branch block your pain may
- Go away for a few hours
- A few days or
- Not reduce at all
If the pain is relieved after the medial branch block, this indicates that the origin of the pain is the medial branch nerves that were numbed. Your doctor may then recommend a radiofrequency ablation or an endoscopic rhizotomy to relieve the pain for a longer period of time. With the radiofrequency technique, the nerves regenerate over time and the pain returns after a few months. With the endoscopic technique, a section is cut from the nerve, preventing the nerve from being able to regenerate.
Endoscopic rhizotomy is an outpatient surgery. You will be taken to the pre op area where trained nursing staff will get you ready for the procedure, by taking vitals and reviewing your medications. Your blood sugar and coagulation status may also be checked if needed. Then you will enter the procedure room where you will lie face down on a table for treatment of the painful area.
The surgery is done under deep sedation and there is no pain during the surgery. A small (7mm) incision is made in the surgical area and a tube with a camera is inserted into the spine. The doctor is guided by fluoroscopic X-ray to place the camera in the correct position.
The camera allows the surgeon to see the inside of the spine where the nerve usually resides. The surgeons use a microscopic cauterizing instrument to find the small nerve branches that supply the joints in the spine. After identifying the nerve, a small section is cut from the nerve, preventing any regrowth in the future.
The camera is removed and the incision is closed with a single absorbable suture that is buried under the skin, so that no suture removal is needed. The procedure takes about 45 minutes to complete but may take longer depending on the number of nerves required to be treated.
Risks and Complications
With the use of careful imaging allowing direct visualization of the spine and physicians trained in the latest endoscopic techniques, complications are rare. But with all medical procedures, complications may occur. To help minimize risks please follow all directions given to you by your care provider. Have all your treatment options explained so you are aware of the risks and benefits of these procedures.
Some complications may include:
- Infection: Your surgeon cleans and sterilizes your back before every procedure to prevent this from occurring. On rare occasions oral antibiotics may be needed
- Allergic reaction: This may occur if you have allergies to any medication used. Typically this is pretreated and on occasion your physician may recommend medications for you to take after the procedure. Pay close attention to any rashes and difficulty breathing because that may indicate need for emergency attention
- Increased pain may occur after the procedure in the area where the camera was placed. This may last up to a week or rarely longer. However typically it resolves completely
- You may also experience an area of numbness, usually in the area which was originally painful
- The procedure may take up to 6 weeks for complete benefit, so improvement may not be immediate
You will need someone to drive you home once you are discharged. As always, follow the instructions of your care provider and have your questions answered prior to the procedure.