Many struggling with chronic neck or lower back pain seek one thing: relief from the pain. This is precisely what can be achieved with endoscopic facet rhizotomy, a minimally invasive spine surgery used to deaden pain-causing nerves, according to interventional pain management specialist Kaliq Chang, MD, with Atlantic Spine Center.
According to Dr. Chang, "facet joints are often a primary source of pain because they are almost constantly in motion as we move about and can break down as we age and from repetitive injury." "Since facet joint pain is one of the most common causes of back pain, endoscopic facet rhizotomy surgery has become more and more popular and useful," says Dr. Chang. "Our patients often feel better very quickly after facet rhizotomy surgery and report that the surgery ends the muscle spasms often triggered by facet joint pain."
Treatments for Neck Pain: Expert Solutions
Dr. Chang explains the painful syndrome that can be best treated with this surgery:
Facet joint syndrome: Facet joint syndrome (also sometimes called facet disease) progresses as the discs between vertebrae become thinner, resulting in more stress being placed on the facet joints. This syndrome is most common in seniors or the very active, where increased stress between facet joints causes inflammation and the formation of spinal bone spurs. This process can lead to arthritis, which infamously can result in pain upon joint movement.
Often, for patients of facet joint syndrome, the first step in treating chronic pain in the neck or lower back will be with non-surgical approaches including medication and physical therapy. But if these treatments fail to provide adequate relief, a more advanced diagnostic technique called a medial branch block injection, is employed. This technique or preoperative evaluation, which is performed by Dr. Chang at Atlantic Spine Center, consists of an injection of an anesthetic agent into the space immediately surrounding the joint. Depending on whether or not back or neck pain is alleviated by the anesthetic agent, diagnostic information can be obtained. If the pain does not subside, it can be concluded the pain was not emanating from the joint.
What is Endoscopic Facet Rhizotomy?
The word "rhizotomy" means "nerve destruction," and endoscopic facet rhizotomy surgery uses heat energy to extinguish tiny nerve fibers that send pain signals from the facet joints to the brain. The procedure only requires a small incision (compared to traditional "open" surgery) and can provide significant neck or lower back pain relief without disrupting the architecture of the spine.
Pain can result from diseased facet joints in the neck, shoulders, mid-back, ribs, chest, lower back, buttocks, groin or legs. To say it another way, facet joint pain can affect many vital areas of the body, resulting in chronic pain and a diminished quality of life for sufferers. By destroying ("ablating") these exact nerve fibers, endoscopic facet rhizotomy can greatly improve patients' lives by precisely targeting the source of this pain, says Dr. Chang.
The short surgery involves the use of a local anesthetic, x-ray guidance and direct visualization through a microscopic camera to guide an electrocautery device to destroy nerves supplying sensation to damaged facet joints. "The relief experienced by most patients who undergo this procedure can last for years," adds Dr. Chang.
Choosing Endoscopic Facet Rhizotomy Surgery
Today, the most common treatment performed by pain management doctors after a patient has been diagnosed with facet syndrome with a positive medial branch block is radiofrequency ablation. This procedure uses heat from electrical currents administered to the patient via a needle to numb effected nerves. While radiofrequency ablation deadens a small area around the nerve and is expected to last roughly 6 months before the nerves grow back, endoscopic rhizotomy can affect a much larger area through direct visualization, resulting in much longer periods of pain relief.
Dr. Chang concludes that with endoscopic facet rhizotomy "the relief experienced by most patients who undergo this procedure can last for months or even years. This reprieve is profoundly welcomed by people with chronic neck or lower back pain."
Benefits of Endoscopic Facet Rhizotomy Surgery
This innovative surgical technique offers numerous benefits to patients suffering from persistent pain that hasn't responded to conservative treatments.
One of the most significant advantages of this procedure is its minimally invasive nature. Unlike traditional open surgeries, Endoscopic Facet Rhizotomy involves smaller incisions and uses specialized instruments to access the affected area. This leads to reduced trauma to surrounding tissues, quicker recovery times, and a lower risk of complications.
Endoscopic Facet Rhizotomy is specifically designed to target and disrupt the nerves responsible for transmitting pain signals from the arthritic facet joints. By using radiofrequency energy to ablate or denature these nerves, the procedure effectively blocks the transmission of pain signals, providing lasting relief for patients.
While the nerves are not permanently damaged, the effect of the procedure can last for an extended period, often providing pain relief for several months to years. Some patients may experience complete pain resolution, while others may require periodic treatments for continued relief.
Chronic back pain can severely impact a person's quality of life, restricting mobility, and hindering daily activities. Endoscopic Facet Rhizotomy can significantly improve patient's quality of life by reducing or eliminating pain, allowing them to return to normal activities and enjoy a more active lifestyle.
Many individuals suffering from chronic back pain rely on pain medications for relief. Prolonged use of pain medications can lead to adverse side effects and dependency issues. Endoscopic Facet Rhizotomy offers an alternative by addressing the source of the pain, potentially reducing the need for pain medications.
Due to the minimally invasive nature of the procedure, patients generally experience shorter recovery times compared to traditional open surgeries. Most patients can resume light activities within a few days and gradually return to their regular routine in a matter of weeks.
Endoscopic Facet Rhizotomy is often performed as an outpatient procedure, meaning patients can return home on the same day. This reduces hospital stays, costs, and potential exposure to hospital-acquired infections. Unlike some other spine surgeries, Endoscopic Facet Rhizotomy does not involve fusion of the spine. This means that the natural motion of the spine is preserved, reducing the risk of adjacent segment degeneration.
The endoscopic approach allows the surgeon to visualize the targeted area in real-time using a specialized camera. This enhanced visualization facilitates precise and controlled treatment, minimizing the risk of complications and improving the overall success of the procedure.
Endoscopic Facet Rhizotomy may serve as a viable alternative for patients who are not suitable candidates for more invasive spinal surgeries or those who wish to explore non-surgical options first.
Watch our 3D animated Educational Video on Endoscopic Facet Rhizotomy
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