Endoscopic Rhizotomy: What is it, What Conditions Does it Treat and Benefits

Endoscopic Spine SurgeryTreatments

It makes sense that joints constantly in motion might deteriorate from wear and tear, causing chronic pain. That's precisely what can happen to facet joints in the spine, which a procedure known as endoscopic rhizotomy can relieve, according to Kaliq Chang, MD, of Atlantic Spine Center. Not fully understanding or not having accurate information about an endoscopic rhizotomy, or facet rhizotomy, can discourage those with lingering neck or lower back pain from seeking the procedure even though they might greatly benefit. Dr. Chang, a highly specialized interventional pain management specialist helps resolve some of these questions.

What is Endoscopic Rhizotomy

"The word 'rhizotomy' means 'nerve destruction,' which is what the minimally invasive spine surgery aims to achieve," Dr. Chang explains. “Endoscopic discectomy uses energy to selectively destroy tiny nerve fibers carrying pain signals from the facet joints to the brain. Research backs up its benefits, showing it can significantly improve pain levels in the neck or back compared to other treatments such as steroid injections."

What Conditions Does Endoscopic Rhizotomy Treat

What are the top reasons a doctor might recommend endoscopic rhizotomy? According to Dr. Chang, they include:

  • Facet joint syndrome: This condition develops when discs between spinal vertebrae become thinner, which places additional stress on facet joints. More common in seniors, the syndrome leads to the inflammation and bone spur formation characterizing arthritis. "Of course, arthritis is known for how painful it is, especially when the affected joints are moving," Dr. Chang says. "When is our back not moving? Very infrequently."
  • Chronic neck or back pain: So-called conservative treatments, such as medication and physical therapy, are typically used to treat lingering neck or back pain before surgery is ever considered. But when nothing else provides relief, doctors can apply advanced diagnostic and pain mapping techniques to determine whether an endoscopic rhizotomy might do the trick.
  • Failed back surgery syndrome: If surgery on the neck or lower spine doesn't work – which can happen with invasive or drastic procedures – it's called failed back surgery syndrome. "But endoscopic rhizotomy can help ease stubborn pain by helping affected muscles finally stop having spasms and relax," Dr. Chang notes.

When Is An Endoscopic Rhizotomy Procedure Recommended

Endoscopic rhizotomy is typically recommended when conservative treatments, such as medications, physical therapy, or nerve blocks, have failed to provide adequate relief from chronic pain. It is considered when the pain is localized and originating from a specific nerve or nerve cluster.

The procedure is commonly performed for conditions like trigeminal neuralgia, characterized by severe facial pain, and occipital neuralgia, which involves pain in the back of the head or neck. It may also be used for facet joint pain originating from the small joints in the spine that can cause localized back or neck pain.

How Is The Procedure Performed

During an endoscopic rhizotomy procedure, the surgeon uses a small, flexible tube with a camera called an endoscope to visualize the affected nerve or nerve cluster. This tube is inserted through a small incision or natural body opening, reducing the need for extensive incisions or tissue disruption.

The surgeon guides the endoscope to the target area, where thermal energy (such as laser or radiofrequency) is delivered to selectively disable or destroy the pain-transmitting nerve fibers. The goal is to interrupt the pain signals without affecting other nerve functions.

The procedure is performed under local anesthesia or general anesthesia, depending on the patient's specific needs and the complexity of the case. The surgeon carefully navigates the endoscope to the targeted nerves, ensuring precision and accuracy throughout the process.

How Long Is The Recovery And How Soon Can You Return To Work

Recovery time and the ability to return to work after endoscopic rhizotomy can vary depending on the individual and the extent of the procedure. However, this minimally invasive technique generally offers faster recovery and shorter downtime compared to traditional open surgeries.

Here's the truth about Endoscopic Rhizotomy:

Myth: An Endoscopic rhizotomy is a short-term fix

Fact: Relief can last for months or years

By "ablating" or destroying nerve fibers surrounding diseased facet joints – which, depending on location can produce pain in the neck, shoulders, back, ribs, chest, buttocks, groin or legs – endoscopic rhizotomy surgery effectively targets the source of the pain, Dr. Chang says. "The procedure can be repeated if necessary, but patients typically experience long-term relief that improves their quality of life tremendously."

Dr. Chang adds that the more common form of rhizotomy is radiofrequency spinal or nerve ablation, which is done with just needles, however, the effect is only expected to last 6 months. The endoscopic procedure is only a little more invasive but can provide at least a year, more commonly a couple of years of relief.

Myth: Endoscopic rhizotomy is dangerous Fact: It's both safe and highly effective

At first glance, the idea of destroying nerve fibers can sound hazardous. But endoscopic rhizotomy surgery works with such precision that only pain-producing nerves around the facet joints are affected, Dr. Chang says. "This meticulous approach is not only safer for nerves, but the surgery's minimally invasive approach means only tiny incisions are used," he adds.

Myth: Endoscopic rhizotomy can only help a select few Fact: It's increasingly popular and useful

Because spinal arthritis and other chronic back problems can often originate in the fact joints, endoscopic rhizotomy surgery is an option for a large proportion of back pain sufferers, Dr. Chang says. "The procedure has become even more popular and useful in recent years, since facet joint pain is more prevalent than other diagnosable reasons for back pain," he adds. "With a rapid recovery, most patients feel much better within days."

LEARNING IN MOTION - Watch our 3-D Animated Video on our Endoscopic Rhizotomy webpage for a more detailed look at the procedure.