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Endoscopic Rhizotomy

What is Endoscopic Rhizotomy?

Endoscopic rhizotomy is a minimally invasive procedure to destroy nerves that transmit pain impulses from the facet joints of the spine. Your surgeon uses an endoscope (a narrow tube with a tiny camera) to identify the nerves and destroy them.

What are the Facet Joints?

Facet joints are the joints between the different vertebrae of the spine. There are two joints on either side of each vertebra from the neck to the lower back. Arthritis or injury to the facet joints can cause pain. Pain signals from the facet joints are usually transmitted by small nerves called the medial branch nerves. The location of the pain depends on which facet joint is affected as it can affect the neck, shoulder, mid back, chest, ribs, lower back, buttocks, and legs.

Indications for Endoscopic Rhizotomy

Endoscopic rhizotomy may be indicated for chronic back pain, muscle spasms, and pain while leaning backward. 

To identify the facet joint as the source of your pain, your doctor will perform a facet joint injection or a medial branch block. This injection contains a local anesthetic and steroids and relieves pain when administered in the correct location. The pain relief produced is usually temporary though some find it adequate. An endoscopic rhizotomy has a more lasting effect and may be recommended if the facet joint is identified as the source of pain but facet joint injections and other conservative measures such as rest, pain medication and physical therapy are inadequate.

Endoscopic Rhizotomy Procedure

Endoscopic rhizotomy is performed as an outpatient procedure under sedation and local anesthesia. Under fluoroscopic (live X-ray) imaging, a very small incision is made through the skin and muscle overlying the facet joint. The endoscope is inserted through the incision and the medial branch nerves are identified. Small instruments inserted through the endoscope are used to destroy the nerves. The instruments and endoscope are then removed and the incision closed.  The procedure takes about 30 minutes.

What will I Experience Following Endoscopic Rhizotomy?

Following the procedure, you will be monitored for a short while and can then return home. Strenuous activities such as heavy lifting should be avoided until your doctor clears you. You will usually be able to return to work in a few days or a week.

Advantages of Endoscopic Rhizotomy

The advantages of endoscopic rhizotomy include:

  • Minimally invasive procedure
  • The precise location of the medial branch nerves
  • Minimal blood loss
  • Short recovery
  • Long-term relief
  • North American Spine Society Logo
  • The American Academy of Orthopaedic Surgeons
  • The University Of Virginia