After Conservative Treatments Have Failed, Can an Endoscopic Facet Rhizotomy Procedure Help?

April 30, 2012

What is facet rhizotomy?

To answer this question, we first need to understand what rhizotomy means. Rhizotomy means interruption of a spinal nerve root. And facet rhizotomy really means interrupting nerves from sending pain signals from facet joints (small joints of the spine) to the brain.

Facet joints help support the body weight and enable spine movement. However, they are prone to wear and tear. As we age, facet joints gradually deteriorate and sometimes become arthritic. As a result, facet joints are a common source of back pain. 

The goal of facet rhizotomy is to provide long-lasting pain relief by stopping sensory nerves from sending pain signals from a facet joint to the brain. Physicians often use facet rhizotomy to treat chronic back pain, and pain caused by other facet joint diseases, such as facet joint arthritis, bone spurs, and facet joint injuries.

What is endoscopic facet rhizotomy?

Endoscopic facet rhizotomy means that the procedure of facet rhizotomy is performed with the assistance of a specially designed endoscope. As a minimally invasive procedure, endoscopic facet rhizotomy is generally performed at an outpatient setting.

In general, endoscopic facet rhizotomy is recommend for treating back pain in the following situations:

  • Chronic back pain lasts for more than 6 weeks despite conservative treatments.
  • Palpation of a facet joint provokes deep tenderness and muscle spasm.
  • The patient has limited range of motion (especially bending backwards) in the lumbar spine.
  • Facet joint blocks confirm that the pain is caused by a facet joint disease.

What is an endoscopic facet rhizotomy procedure like?

An endoscopic facet rhizotomy procedure is generally performed under local anesthesia and light intravenous sedation. The surgical targets are marked on the skin surface under fluoroscopic guidance. After a small cut (about 7 mm) is made on the skin, a specially designed endoscope is carefully inserted. Under direct vision, the small nerve branches (known as medial branch) from the nerve root are identified. A laser is then used to kill the nerve branches, which only have a sensory function. After that, the endoscope is removed, the incision is closed with one or two stitches, and the endoscopic facet rhizotomy procedure is complete.

After an endoscopic facet rhizotomy procedure, the patient is encouraged to walk around. In the company of a family member or friend, the patient is free to leave the surgical center the same day. After a follow-up visit with the surgeon the next day, the patient can go home for recovery.

Can an endoscopic fact rhizotomy procedure help after conservative treatments have failed?

For back or neck pain caused by facet joint disease, the answer is yes. As we discussed earlier, endoscopic facet rhizotomy can help relieve pain after conservative treatments have failed. It can also help relieve the pain after a surgical procedure has failed.

If you are interested in using this procedure to relieve pain, you are welcome to make an appointment to speak with one of our experienced surgeons. To learn more about endoscopic fact rhizotomy procedure, please visit