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The endoscopic rhizotomy procedure provides visualized ablation and transection of nerves that can cause disabling facet joint pain in the spine. This advanced endoscopic ablation technique provides two major advantages over standard radiofrequency lesioning techniques. First, the endoscope allows for direct visualization of the nerve and permits confirmation that the nerve has been accurately targeted. Second, a specialized endoscopic radiofrequency probe is used to definitively transect a segment of the nerve to ensure complete interruption of pain signals. The definitive transection of the medial branch nerve provides the patient with more complete pain relief of longer duration than traditional radiofrequency ablation procedures.
Patients who have received significant relief of pain from medial branch blocks and/or from radiofrequency ablation (RFA) of the spine are good candidates for the endoscopic rhizotomy technique. Furthermore, patients that have had RFA procedures of the spine that have been short lasting in duration will find that endoscopic rhizotomy provides similar pain relief with significantly longer duration.
Endoscopic rhizotomy is an outpatient surgical procedure. The procedure takes placed at an Ambulatory Surgical Center, where trained staff will prepare you for the procedure. Your vital signs will be obtained and your medical history and medications will be reviewed. An IV will be started to provide sedation for the procedure. 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 procedure is performed utilizing deep sedation and you will feel as though you are asleep until awaking in the recovery area. Unlike traditional RFA procedures, the physician can directly visualize all relevant anatomy so there is no need for you to be awake for motor/sensory testing or feedback. Very small skin incisions are made over the area of the painful joint and a small camera is inserted into the spine. The doctor is guided by fluoroscopic X-ray to place the camera in the correct position. Since the physician is able to fully visualize the anatomy rather than relying only on x-rays, less harmful radiation is used than during traditional radiofrequency ablation.
The camera allows the physician to see the inside of the spine where the nerve usually resides. If the nerve is in a different position of the spine than usual, it can easily be located at the time of the procedure. The physician uses 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. If desired, the camera can then visualize the affected joint itself to provide directly visualized regenerative treatment.
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.