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Christopher Yeung, MDChristopher Yeung, MD

What are the Advantages of an Endoscopic Rhizotomy?

By Christopher Yeung, MD

Dr. Christopher Yeung is a board-certified, fellowship-trained orthopedic spine surgeon, with a special interest in minimally invasive spine surgery techniques with a philosophy of choosing the least invasive yet most effective method to treat spine problems.

July 22, 2022

Our spine is the critical musculoskeletal organ in our body, supporting us in every movement we make. Thus, when structures within our spine malfunction or cause discomfort, it can have widespread effects. Since chronic lower back pain is one of the most common complaints among the general population, with an estimated 60 to 80% of people dealing with it at some point in their lives, it’s a critical issue to address. One effective solution to the travails of chronic low back pain is endoscopic rhizotomy.

Learn more about this innovative and minimally invasive spine surgery in this article!

What Is an Endoscopic Rhizotomy?

To explain an endoscopic rhizotomy, it’s perhaps helpful to define each word. Let’s start with rhizotomy. A rhizotomy is a surgical procedure where a spinal surgeon severs or removes the medial branch nerve, which extends from the nerve roots of the spinal cord. Medial branch nerves have many functions within the brain and nervous system, including sending pain signals from the facet joints to the brain.

At times, these pain signal carrying nerves malfunction and cause reduced quality of life for patients. If your medial branch nerves are sending excessive or faulty pain signals to your brain, your doctor may recommend a rhizotomy procedure to stop these problematic nerves from doing their job.

In other words, a rhizotomy provides relief to patients dealing with chronic back pain conditions, such as:

  • Arthritis of the spine, especially if it is facet-related.
  • Chronic lower back pain or spasms.
  • Facet joint syndrome.
  • Failed back surgery syndrome.
  • Sacroiliac joint disorder.
  • Spinal stenosis.

A radiofrequency probe is the primary instrument surgeons use to perform an endoscopic rhizotomy. Pain management physicians use a radiofrequency needle to ablate only under X-ray through the skin.  This procedure, commonly called radiofrequency ablation (RFA), is not visualized like an endoscopic rhizotomy. That’s why you might also hear this procedure called a radiofrequency neurotomy.

RFA involves the use of radio waves that generate heat to vaporize targeted tissues — such as medial branch nerves. It is a non-ionizing form of radiation. By being non-ionizing, RFA does not have enough energy to remove electrons from an atom. Thus, RFA poses minimal cancer risks compared with other energy sources using radio waves.

Here are some differences between endoscopy rhizotomy and radiofrequency ablation:

  • RFA is less invasive than endoscopic rhizotomy, but offers shorter-lived pain relief.
  • RFA is performed by pain management doctors percutaneously (needle stick) through the skin under X-ray. The endoscopic surgeon visualizes the target nerve and then with confidence severs the nerve.
  • RFA only applies a lesion to the nerve, temporarily turning off the nerves ability to transmit a pain signal. In contrast, endoscopic rhizotomy surgically severs the nerves which offers long-term relief. 

The endoscopic part of the equation refers to how surgeons access the painful medial branch nerve. With endoscopy, surgeons insert a thin, metal tube through a quarter-inch incision in your skin and then insert a tiny endoscope with an attached HD camera. The camera/endoscope affords visualization of the nerve during a rhizotomy projected onto an HD monitor. The surgeon inserts the minuscule surgical instruments through the endoscope inside a 7 mm metal cannula to perform the rhizotomy. Endoscopy is an ultra minimally invasive surgical option. Such procedures shorten recovery times and can take place in an outpatient setting.

What to Expect Before, During and After the Procedure

Before you pursue an endoscopic rhizotomy for chronic low back pain, it’s helpful to know what to expect with the procedure. Each procedure has unique preparations, detailed processes and recovery considerations. Here is what you can expect before, during and after an endoscopic rhizotomy procedure. 

  • Before

    Before an endoscopic rhizotomy, most patients receive intravenous sedation to ensure they do not feel any pain during the procedure. You must take specific preparatory measures for IV sedation, which usually involve no eating or drinking for several hours beforehand. Your surgeon will let you know the exact amount of time before the surgery that it is necessary to go without eating or drinking. 

    When you arrive and check in for your endoscopic rhizotomy appointment, a nurse or medical assistant will direct you to a private room. They will also give you a hospital gown to change into. The hospital gown helps the procedure proceed smoothly and allows the surgeon easy access to the surgical site. After you’ve changed into your gown, a nurse or medical assistant will ask you to get on the hospital bed. 

    Once you’re comfortable and ready, they will place an IV line into your arm and wheel you to the operating room. The IV line will administer a sedative before the procedure begins. Some patients fall asleep with the sedative, while others remain awake, responsive and relaxed. 

  • During

    The surgeon will wait until the sedative fully takes hold before beginning the procedure. They will also inject a local anesthetic on the skin and percutaneously to the affected nerve to further prevent any pain. As soon as they can verify that you will not feel discomfort with the procedure, the surgeon will begin. 

    Fluoroscopy, a type of X-ray-guided imaging, shows the doctor where to place the needle containing a local anesthetic. During fluoroscopy, an X-ray beam continually passes through the area undergoing surgery. The X-ray then creates an impression of that part of your body and transmits it to a nearby display screen. The surgeon watches this screen as they insert a needle to inject an anesthetic into the problematic nerve. 

    After administering the anesthetic, the surgeon will insert a small metal dilator and cannula through a quarter-inch incision. The dilator expands the opening, while the cannula is a tube through which small surgical instruments can pass. With the cannula in place, the surgeon inserts an endoscope so they can visualize the area. 

    Then, the doctor introduces a radiofrequency probe to ablate and sever the problematic nerve root. When the RF probe severs the problematic nerve root, it cuts off pain signals from your back to your brain. Once they have cut the nerve, the surgeon will remove the cannula and close the incision with one small stitch and/or surgical tape. 

  • After

    Since endoscopic rhizotomy is an outpatient procedure, you can return home afterward. Please arrange a ride home, since you will still be groggy from the sedative. Most patients can return to work the following day. Still, some precautions are necessary, including the following:

    • Avoid strenuous activity and heavy lifting until your surgeon has advised you can. 
    • Avoid taking a bath, swimming, soaking in a hot tub, or immersing yourself in water for 24 hours — you can still shower as usual. 
    • Your doctor may recommend wearing a back brace to support your spine as it heals. 

    It can take a couple of weeks before you fully recover from an endoscopic rhizotomy and experience maximum pain relief. During this time, it’s common to experience mild bruising, soreness, swelling, and general discomfort. To cope with this discomfort, you can use ice packs and over-the-counter pain medication, per your doctor’s instructions. 

    Whereas RFA provides pain relief for six months to a year, back pain relief with endoscopic rhizotomy lasts up to five years. RFA ablation places a lesion over the nerve, while endoscopic rhizotomy severs it altogether. The nerves regenerate and the pain returns much faster with RFA than with endoscopic rhizotomy. The long-lasting results make endoscopic rhizotomy an ideal alternative to lumbar spinal fusion for many select patients. 

Who Needs an Endoscopic Rhizotomy?

If any of the following applies to you, you may be an ideal candidate for an endoscopic rhizotomy:

  • Low back pain related to the facet joints for six weeks or more
  • Low back pain that improves by 50% or more with a medial branch nerve block or facet joint injection
  • RFA fails to provide lasting pain relief
  • Back spasms when doctors perform palpation on your lower back
  • A doctor has recommended that you consider spinal fusion surgery, but you’re seeking an alternative, less invasive procedure

The official indications for endoscopic rhizotomy are:

  • A medial branch block has confirmed facet joint pain.
  • Conservative treatments fail to bring adequate relief within six weeks.

A medial branch block is a diagnostic injection determining if a facet joint is causing the pain. Your facet joints connect the vertebrae in your spine. Each vertebral segment has two facet joints. Some symptoms of facet joint pain include:

  • Localized pain within the lower back or referred pain in the hips, buttocks, thighs or knees.
  • Radiating pain along the affected nerve.
  • Tenderness whenever you gently press the painful joint.
  • Stiffness in the affected joint.
  • Sensations of grinding or grating when you move the affected joint. 

What Are the Advantages of an Endoscopic Rhizotomy?

Endoscopic rhizotomy has many advantages, which are especially outstanding compared to other procedures like RFA or spinal fusion surgery. Unlike these procedures, endoscopic rhizotomy merges accurate and thorough results with minimally invasive methods for long-lasting pain relief and short recovery periods.

Other approaches for treating chronic low back pain are either less invasive with inferior results or more invasive with comparable results. Still, sometimes such procedures are necessary. Here are some advantages of choosing an endoscopic rhizotomy as your low back pain solution. 

Minimally Invasive

A considerable advantage of endoscopic rhizotomy compared with other spinal surgeries is its status as a minimally invasive spinal surgery. As an endoscopic procedure, this type of rhizotomy requires smaller incisions than most spinal surgeries. Invasive surgeries like spinal fusion require large incisions so the surgeon can visualize the area they are operating on.

In contrast, endoscopic rhizotomy incisions only need to be big enough for the endoscope and cannula to fit through. The surgeon can then see the area they’re operating on using the endoscope for the entire procedure. 

The smaller incisions also ensure minimal to no blood loss during the procedure, significantly reducing the risk of complications.

Outpatient Procedure With a Short Recovery Time

Endoscopic rhizotomy is an outpatient procedure, so you can return home shortly after your surgeon finishes operating. Outpatient surgeries are also known as day surgery, which involves less than one day of your time. There are no extended hospital stays with an endoscopic rhizotomy, allowing you to recover in the comfort of your home. 

Moreover, since it is a minimally invasive outpatient procedure, endoscopic rhizotomy has a short recovery time. Less invasive surgeries like endoscopic rhizotomy inflict minimal damage to the surrounding tissues. There is less to recover from with endoscopic rhizotomy than from invasive procedures like spinal fusion surgery. 

High Success Rate

Studies show endoscopic rhizotomy success rates are as high as 96.7% after one year, which means you are more than likely to feel satisfied with the pain relief endoscopic rhizotomy provides. Most patients experience post-procedure pain relief for approximately five years. The high success rates with endoscopic rhizotomy are a product of the thorough, accurate and less invasive methods this procedure uses to correct chronic low back pain. 

Endoscopic rhizotomy is more effective than RFA for back pain because it involves severing connection of the affected nerve rather than placing a lesion on the nerve. Using an endoscope to identify the precise nerve to operate on ensures great accuracy with endoscopic rhizotomy. Additionally, the less invasive aspect of endoscopic rhizotomy provides patients maximum satisfaction with their procedure.  Finally, endoscopic rhizotomy affords patients upto five years of long-term relief compared to RFA results averaging only six months pain relief.

Maintain Spinal Mobility

As an ultra minimally invasive procedure, endoscopic rhizotomy causes little to no damage to the muscles and soft tissues surrounding the nerve. As a result, endoscopic rhizotomy relieves pain without sacrificing your spinal mobility. When surgeries cause necessary damage to these tissues, scar tissue grows over the controlled injuries. Scar tissue reduces soft tissue flexibility and mobility. Endoscopic rhizotomy procedures also limit scar tissue growth by limiting the amount of damage to these tissues, preserving your spine’s flexibility. 

Should You Get an Endoscopic Rhizotomy?

If you are dealing with chronic lower back pain within your facet joints, there are many reasons to get an endoscopic rhizotomy. Still, it’s essential to consider whether endoscopic rhizotomy is the right procedure for you. 

If you’re dealing with chronic lower back pain and exhibit some of the symptoms of facet joint pain, you should speak with a doctor. Your doctor can tell you if endoscopic rhizotomy is a good solution for you. Likewise, endoscopic rhizotomy is an excellent option to consider if you have a facet joint disorder and failed to find significant pain relief with other treatment methods. 

Schedule a Consultation Today

The spine specialists at the Desert Institute for Spine Care have provided successful, least invasive spine surgeries to patients from Phoenix, Ariz., and the surrounding areas since 1998. Our surgeons prioritize the least invasive approach with each treatment solution for our patients’ back pain problems. We want to solve your back pain in ways that allow you to continue to enjoy life as much as possible. To do so, we get to know each patient individually so we can personalize our approach to your unique needs. 

If you would like to learn more about our endoscopic rhizotomy procedures at the Desert Institute of Spine Care, we encourage you to schedule a consultation with us today

LEADERS IN MINIMALLY INVASIVE SPINE CARE
1635 E. Myrtle • Suite 400 • Phoenix, AZ 85020
Ph: 602-944-2900 • Fax: 602-944-0064

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