Full Endoscopic Rhizotomy

What is Endoscopic Rhizotomy?

Endoscopic rhizotomy is a minimally invasive outpatient procedure which allows the surgeon to directly visualize the dorsal ramus branch of nerves which are distributed within the facet joints of the spinal vertebrae. Facet joints connect spinal vertebrae together. These nerves send pain signals from the back region to the brain. Ablation (killing of nerve fibres) and severing of these nerves provides pain relief from back and neck pain for a long period of time. Patients who have not achieved long-term results with procedures like spinal injections, nerve blocks or percutaneous radiofrequency rhizotomies are considered as good candidates for Endoscopic Rhizotomy procedure.

Indications of Endoscopic Rhizotomy:

The following conditions may be recommended for treatment with Endoscopic Rhizotomy:

• Chronic lower back pain
• Facet joint related arthritis
• Facet joint related back and muscle spasms
• Increased back pain while bending backwards
• Failed back surgeries
• Patients with short-term relief from previous percutaneous rhizotomy
• Lower back palpations causing pain
• Disorders of the Sacroiliac Joint (SI joint: joint between the spine and pelvis)

Endoscopic Rhizotomy procedure

The patient is administered with local anaesthesia, after which the surgeon marks the targeted facet joint area. A small incision of around 7mm is then made on the back in the marked area, followed by insertion of a small tube. Now a HD camera is sent inside the tube for direct visualisation of the medial branch nerves.

 Next, the surgeon uses small microscopic instruments to cut/severe the medical branch nerves in order to prevent the pain signals from reaching the brain through these nerves. Finally, the tube is removed and the incision is closed with a single stitch and a band aid to cover it. The entire procedure may take about one hour on an average.

Post-operative patient care

Post-surgery, patients may feel mild pain, swelling and discomfort in the area of incision, however these symptoms subside within a few days. In some cases patients may use over-the counter pain relief medications and ice packs. Most of the patients who have undergone the endoscopic rhizotomy procedure may return to their daily routine activities the next day, although some precautions are advised to be taken. They include avoiding strenuous exercises and lifting heavy weights until the surgeon has advised to do so. Taking a shower must be avoided for at least one day after the surgery.

Recovery

Research indicates that endoscopic rhizotomy procedures for lower back pain provide maximum pain relief within 2 weeks after surgery with significant improvement right after surgery. Majority of patients experience pain relief for up to 5 years.

Advantages of Endoscopic Rhizotomy

Endoscopic Rhizotomy has a number of advantages over percutaneous radiofrequency ablation. These include:

• Long term pain relief
• Accurate identification of targeted nerve fibres
• Minimally invasive
• Quick recovery
• Favourable results with a one-time procedure