What is a minimally Invasive Endoscopic Rhizotomy surgery?
An Endoscopic Rhizotomy is a minimally invasive endoscopic surgery that allows direct visualization of the medial branch nerves that supply the 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 vertebrae of the spine to each other. The joints are present on both sides of the spine from the neck to the lower back.
The surgery takes the percutaneous radiofrequency ablation procedure (RFA), a common procedure where we use special needles and electrical current to turn off the nerves, an important step further by providing direct endoscopic visualization of the posterior spinal anatomy and nerves.
What is the difference between radiofrequency ablation and an Endoscopic Rhizotomy?
Radiofrequency ablation is a procedure for back pain where we use special needles and electrical currents to turn off the nerves and their ability to transmit pain signals. Usually provides 6-12 months of relief. By that time, the nerve may heal and the pain may return.
The surgical aspect of a rhizotomy is a little more invasive, but still considered an endoscopic minimally invasive surgery or procedure. The incision is smaller than a centimeter and involves the use of a camera through which we can use special tools to identify the nerves, surgically remove those nerves, and then perform an ablative procedure under direct visualization.
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
- High success rate and sustained success of the therapy
- No or minimal blood loss
- Spinal mobility is maintained
- Visual endoscopic control of the treatment
When is an Endoscopic Rhizotomy Recommended?
Patients suffering from chronic low back pain related to the facet joints for more than six weeks should seek a second opinion before major spinal surgery.
Suppose you failed to get long-term relief from a pain management radiofrequency ablation (RFA) procedure. In that case, you might be a candidate for an endoscopic rhizotomy.
Some patients offered spinal fusion surgery for low back pain may benefit instead from an endoscopic rhizotomy as a less invasive alternative.
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 that 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 monitored 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 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 see where the medial branch nerves usually reside. After identifying the nerve, a small section is cut from the nerve, preventing any regrowth in the future.
What are the Expected Recovery and Success Rates of an Endoscopic Rhizotomy?
After an endoscopic rhizotomy, some patients may experience mild swelling, discomfort, and soreness around the skin incisions. These symptoms may linger for a few days up to a couple of weeks. Patients typically use over-the-counter pain relievers and an ice pack to provide relief.
Most patients can return to work and normal activities the next day. However, they should avoid strenuous exercise and heavy lifting until advised by the surgeon. Taking a shower, soaking in the bathtub, or swimming should be avoided until at least 24 hours after surgery.
In our experience and our published research, patients who have an endoscopic rhizotomy can expect low back pain to be significantly improved post-operatively and continue to improve to maximum pain relief in about two weeks. This pain relief, as reported in clinical research, can last up to 5 years.
Before and After the Procedure and the Risks
Before the Procedure
Since you will be receiving medication, it is recommended that you do not eat within four or five hours before the procedure. If you are a diabetic, be sure to discuss your eating and medication schedule with your doctor. You may need to stop taking certain medications several days before the procedure. Please remind the doctor of all prescription and over- the-counter medications you take, including herbal and vitamin supplements. The doctor will tell you if and when you need to discontinue the medications. It is very important to tell the doctor if you have asthma, had an allergic reaction (i.e. hives, itchiness, difficulty breathing, any treatment which required hospitalization) to the injected dye for a previous radiology exam (CT scan, angiogram, etc) or if you have had an allergic reaction to shellfish (shrimp, scallops, lobster, crab). The doctor may prescribe some medications for you to take before having the procedure. Tell the doctor if you develop a cold, fever, or flu symptoms before your scheduled appointment.
After the Procedure
After your discharge from the pain center, it is very important that you engage in activities which would normally provoke your pain. If you do not, the test will not give a valid result. Remember, this is a temporary procedure and return of your pain is expected. Please note when your pain returns. Also, you will need to call the pain nurse on the same day, 2-3 hours after your discharge to discuss how the block worked. The results of this test will then determine what further diagnostic or therapeutic procedures will be needed.
The risks, although infrequent, include: Allergic reaction to the medication; Nerve damage; Bruising at the injection site; Infection at the injection site; Injection of medication into a blood vessel.