Endoscopic Rhizotomy

Endoscopic Rhizotomy

What is an endoscopic rhizotomy?

An endoscopic rhizotomy allows for visualization and subsequent anatomical division of the nerves which sense pain from your facet joints.

Where are the facet joints?

Facet joints are in the posterior column of your spine, this is behind your spinal cord. Facet joints are small joint capsules that have nerve endings. Facet joints become inflamed with increased load bearing stress, which arises when there is an issue with the anterior column of the spine, ie. your vertebral discs.

How is an endoscopic rhizotomy performed?

An endoscopic rhizotomy is an outpatient procedure that is performed through a 7mm tube, after a 1/4 inch incision is performed.

What is the common presentation for facet mediated pain?

Lumbar spine rigidity, with radiation to the glutes and thigh above the knee. Symptoms are often aggravated with extending your spine (reaching to the sky) or twisting.

What is the purpose of endoscopic rhizotomy?

endoscopic rhizotomy aims to precisely divide the pain sensing nerve branches in a way that is different than the pinpoint lesions observed with other forms of rhizotomy, which is also referred to as a radiofrequency ablation (RFA).

How long could the relief of facet pain last with endoscopic rhizotomy?

Due to anatomical division of the pain sensing nerve, duration of relief lasts 2 to 3 times as long with endoscopic rhizotomy compared with percutaneous radiofrequency ablations.

What are the advantages of endoscopic rhizotomy compared with Percutaneous radiofrequency ablations?

Endoscopic rhizotomy offers the unique benefit of directly visualizing nerve anatomy. Visualization of nerve anatomy that may vary in location enhances precision, leading to results that are better, and more consistent. With visual confirmation, endoscopic rhizotomy can employ a technique that allows for a larger area for nerve division to occur; this leads to better and more reliable patient outcomes. Fluoroscopically guided radiofrequency ablation only allows for pinpoint lesions without visual confirmation of the nerves. Pain relief from endoscopic rhizotomy occurs sooner compared to the 4-6 week wait with fluoroscopically guided radiofrequency ablation.

What makes a patient a good candidate for endoscopic rhizotomy?

While facet mediated pain is generally a clinical diagnosis, your physician has the benefit of utilizing diagnostic medial branch blocks to improve the decision making process.

What might make me a bad candidate for this procedure?

Limited to no relief from diagnostic medial branch blocks is the most accurate way to tell if you are a bad candidate for an endoscopic rhizotomy. Lastly, a thorough discussion with your health care provider should bring to light factors, such as existing anatomical pain generators which may affect your relief pattern negatively.