When lingering neck or lower back pain flares up, all we really want is to stifle the hurt. That’s exactly what can be accomplished with endoscopic facet rhizotomy, a minimally invasive spine surgery used to deaden affected nerves causing this pain, according to spine specialist Kaixuan Liu, MD, PhD, founder and president of Atlantic Spine Center.
As part of the connection between two adjacent vertebrae in the spine, the facet joints are often the primary source of pain for many back pain sufferers because these joints are almost constantly in motion and can break down from wear and tear and repetitive injury as we age.
With the word “rhizotomy” meaning “nerve destruction,” endoscopic facet rhizotomy surgery uses energy to selectively destroy tiny nerve fibers that carry pain signals from the facet joints to the brain. A 2010 study in the International Journal of Medical Sciences suggested that the procedure – which requires only a small incision compared to traditional “open” surgery – can provide significant neck or lower back pain relief compared to other therapies to eradicate facet joint pain, including spinal steroid injections.
“Since facet joint pain is even more common than other diagnosable causes of back pain, endoscopic facet rhizotomy surgery has become increasingly popular and useful,” explains Dr. Liu, who is fellowship-trained in minimally invasive spine surgery. “Treating facet joint problems can greatly relieve the powerful muscle spasms it often triggers, which can force the spine out of alignment. With this quick procedure, patients often feel remarkably better very quickly.”
Top 3 reasons for endoscopic facet rhizotomy
While endoscopic facet rhizotomy surgery aims to relieve facet joint problems stemming from many possible causes, Dr. Liu says three of the most common reasons for the procedure include:
Chronic neck or lower back pain: Almost invariably, chronic pain in the neck or lower back will be treated first with non-surgical approaches such as medication, physical therapy and other “conservative” measures. But if these fail, advanced diagnostic and pain mapping techniques, such as those performed at Atlantic Spine, enable not only an accurate diagnosis of what’s causing lower back or neck pain, but can identify whether an endoscopic facet rhizotomy might solve the problem.
Facet joint syndrome: Sometimes called facet disease, facet joint syndrome develops as the discs between vertebrae become thinner, placing more stress on the facet joints. This syndrome is more common in seniors as the increased stress between facet joints causes inflammation and the formation of spinal bone spurs leading to arthritis. Arthritic joints notoriously produce considerable pain when the joint is moving – as our backs often are.
Failed back surgery syndrome: Sometimes, surgery on the neck or lower spine – usually the result of invasive or drastic orthopedic treatments – doesn’t relieve patients’ pain or numbness, a result known as failed back surgery syndrome. While the syndrome might be due to several factors, endoscopic facet rhizotomy surgery can relax spastic, clenched muscles with a same-day procedure that offers minimal blood loss and scarring as well as low chance of complications. Also, no additional risks are linked with repeating the procedure if pain should recur.
Advantages of endoscopic facet rhizotomy
Depending on the location of diseased facet joints, pain can result in the neck, shoulders, mid-back, ribs, chest, lower back, buttocks, groin or legs. In other words, facet joint pain can affect many crucial areas – lowering sufferers’ overall quality of life. But, by “ablating” or destroying these specific nerve fibers, endoscopic facet rhizotomy can greatly improve patients’ lives by targeting the source of this pain, Dr. Liu says.
The brief surgery uses local anesthetic and x-ray guidance to place an electrode-tipped needle alongside nerves connected to problematic facet joints. The heated electrode then deadens the nerves that carry pain signals to the brain.
“Steroid injections into the facet joints helps some,” he says, “but for others, this pain relief is too short-lived. This is when endoscopic facet rhizotomy may be the answer. The relief experienced by most patients who undergo this procedure can last for months or years.”
Kaixuan Liu, MD, is a board-certified physician who is fellowship-trained in minimally invasive spine surgery at Atlantic Spine Center.