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Endoscopic Rhizotomy Procedure in Arizona

An endoscopic rhizotomy offered by DISC surgeons in Phoenix, AZ, is the least invasive yet most effective treatment option for chronic low back pain. 

The outpatient procedure, performed through an ¼ inch incision, is the smallest in spine surgery. The endoscopic procedure targets the medial branch nerves located around the facet joints that relay the pain signal in your low back muscles to your brain.

When our surgeons directly visualize these nerves with an HD endoscope, they can ablate the nerve using a laser or radiofrequency probe with confidence, thus providing patients with long-term pain relief.  

The endoscopic rhizotomy procedure was invented and developed at DISC by Anthony Yeung, MD (retired). Dr. Yeung saw a need to improve upon a pain management procedure called radiofrequency ablation (RFA), performed without direct visualization under X-ray guidance.

An RFA only provides patients temporary pain relief for six to twelve months. Endoscopic rhizotomy surgery significantly improves low back pain relief lasting up to five years. For many patients, this procedure is an excellent alternative to a lumbar spinal fusion.

What Symptoms Does an Endoscopic Rhizotomy Treat?

The endoscopic rhizotomy is a highly targeted procedure for patients suffering from low back symptoms related to the facet joints.

  • Low back pain
  • Low back muscle spasms
  • Pain when leaning backward
  • Spinal joint pain

What Conditions Can be Treated with an Endoscopic Rhizotomy?

Proper patient selection is crucial to the success rate of an endoscopic rhizotomy. At DISC, all patients undergo a personalized pain mapping process that selectively pinpoints the low back pain generator. 

Suppose patients get significant (greater than 50%) pain relief from a medial branch injection or facet joint injection. In that case, they typically respond very well to an endoscopic rhizotomy. Endoscopic rhizotomy patients report a 90% success rate with up to 5 years of pain relief.

How is an Endoscopic Rhizotomy Performed?

An endoscopic rhizotomy is genuinely the least invasive outpatient surgery. Before the procedure, our anesthesiologist or trained nurse will place an intravenous (IV) catheter on your wrist and then take you to the operating room. 

Once positioned on the table and comfortable, the anesthesiologist will administer conscious sedative medicine through your IV. Under X-ray, our surgeon will precisely target and mark your painful facet joints or transverse process. Then he injects a local anesthetic at the skin surgical site for your maximum comfort. 

Laser dissects cephalad edge of transverse process

Endoscopically-guided Rhizotomy for Axial Back Pain

Our surgeon then precisely guides a spine needle and guidewire under fluoroscopic X-ray guidance to the transverse process where the medial branch nerve. Next, a small metal dilator and 7mm cannula are inserted through a ¼ inch “keyhole” incision. Finally, an endoscope attached to an HD camera is inserted into the cannula to visualize the medial branch nerves directly.  

The surgeon utilizes a radiofrequency probe or straight firing laser to ablate and sever the medial branch nerve. Severing this small nerve disconnects the pain signal from your back to your brain. Afterward, the cannula is removed from your back, and the incision is closed with a Steris strip band-aid. 
 
The process is repeated for each painful nerve level on one or both sides of your back. The rhizotomy procedure only takes about 30-45 minutes on average.

What are the Advantages of an Endoscopic Rhizotomy versus a Pain Management Radiofrequency Ablation Procedure?

The endoscopic rhizotomy technique is vastly more effective at providing long-term back pain relief than a pulsed or continuous radiofrequency ablation. Both procedures target the pain generator – medial branch nerve of the dorsal ramus, located around the facet joints in your back.

The RFA procedure is done percutaneously under C-arm fluoroscopic X-ray and not directly visualized with the physician’s eye. On the other hand, the endoscopic rhizotomy is directly visualized by the surgeon with an endoscope and HD camera.

The dorsal ramus’s anatomy that innervates the facet joint varies and can contribute to pain management’s failed or short-term results from the RFA procedure. The nerves can also entirely bypass the facet joint, crossing over the transverse process adjacent to the facet joint.

The RFA procedure merely puts a lesion on the nerves through radiofrequency energy. The nerves regenerate, and the pain returns within 6 – 12 months.  

The endoscopic rhizotomy is the most effective method to ablate the branches of the dorsal ramus. The endoscopic procedure allows the surgeon to identify the painful nerves, directly visualize and then ablate the nerves resulting in long-term relief up to 5 years. DISC’s innovative surgery is also less invasive and less surgically morbid procedure than a spinal fusion. The recovery for endoscopic rhizotomy is two weeks versus three months for a spinal fusion.

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.

Recovery

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.

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.

Am I a Candidate?

You may be a candidate for endoscopic rhizotomy if you:

  • Low back pain for more than six weeks

  • Low back palpation by surgeon contributes to pain or spasm

  • Greater than 50 percent relief from medial branch nerve block or facet joint injection

  • Symptoms and pain return after a radiofrequency ablation

If, after reading the above, you believe endoscopic rhizotomy may help you, feel free to contact us for an appointment. Out-of-state and interested in a second opinion? Please fill out our consult request form and a member of the DISC staff will reach out to you immediately.

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