If you suffer from chronic back or neck pain that hasn’t responded to conservative treatments such as physical therapy, medications, or injections, your doctor may suggest endoscopic rhizotomy as a treatment option. This minimally invasive procedure is designed to alleviate pain by targeting specific nerves in the spine that are responsible for transmitting pain signals. Endoscopic rhizotomy has become an increasingly popular option due to its relatively low risk, minimal recovery time, and effective results for many patients.
At Endoscopic & Minimally Invasive Spine Specialists, we have extensive experience and expertise in endoscopic rhizotomy and provide the highest-quality care in surgical and non-surgical spine care.
To learn more about endoscopic rhizotomy surgery, call the office today or request an appointment online.
This guide will provide an overview of endoscopic rhizotomy, including how it works, the conditions it treats, the procedure itself, recovery expectations, and potential risks and benefits, so you can make an informed decision about whether it might be the right treatment for you.
What is Endoscopic Rhizotomy?
Endoscopic rhizotomy is a minimally invasive procedure used to treat chronic pain in the back, neck, or joints, particularly pain that originates from the facet joints in the spine. The procedure targets the medial branch nerves, which are responsible for transmitting pain signals from the facet joints to the brain.
The facet joints are small joints located between the vertebrae in the spine. They allow the spine to move and bend, but they are also a source of pain for many people, especially as they degenerate with age or injury. When these joints become inflamed or arthritic, they can send pain signals that radiate to the surrounding areas, such as the neck, back, or even the legs.
Endoscopic rhizotomy involves using a small tube (endoscope) to access the painful nerve roots and apply heat or radiofrequency energy to disrupt the nerve’s ability to send pain signals. By doing this, the procedure provides long-term relief for many patients suffering from chronic pain caused by facet joint dysfunction or related conditions.
Conditions Treated by Endoscopic Rhizotomy
Endoscopic rhizotomy is primarily used to treat pain that originates from the facet joints, which can be affected by various conditions, including:
- Facet Joint Arthritis (Osteoarthritis): Over time, the cartilage in the facet joints can wear down, leading to inflammation, pain, and stiffness.
- Degenerative Disc Disease: When the discs between the vertebrae lose their cushioning ability, the facet joints can become overloaded, causing pain.
- Spondylosis: This is the general term for age-related changes in the spine, which often include degenerative changes to the facet joints.
- Spinal Stenosis: The narrowing of the spinal canal, which can put pressure on the nerves that pass through the facet joints.
- Spondylolisthesis: A condition in which one vertebra slips over the other, potentially causing damage to the facet joints and nerve roots.
- Trauma: Perhaps the most common indication for endoscopic rhizotomy, acute or repetitive minor or major trauma can cause stretch, disruption, and chronic irritation of the medial branch nerves.
While endoscopic rhizotomy is most commonly used to treat facet joint pain, it can also be effective for other types of nerve-related pain that do not respond to conservative treatments.
Benefits of Endoscopic Rhizotomy
Endoscopic rhizotomy offers several benefits over traditional open surgeries or other treatments for chronic pain, including:
- Minimally Invasive: The procedure involves a small incision on each side (typically less than 1 cm) through which the endoscope is inserted. This means that there is less damage to surrounding tissue, and patients experience less pain and faster recovery than with traditional surgery.
- Quick Recovery: Because it is minimally invasive, recovery from endoscopic rhizotomy is typically remarkably faster than that from more invasive procedures. Most patients can resume their normal activities within a few days to a week.
- Effective Pain Relief: Endoscopic rhizotomy has been shown to provide long-term pain relief, especially for patients with facet joint arthritis or other degenerative spine conditions. The pain relief can last years or even permanently in most cases.
- Reduced Risk of Complications: Compared to traditional surgery, the risks associated with endoscopic rhizotomy are relatively low. It carries a much smaller risk of infection, bleeding, or nerve damage.
- No Absolute Need for General Anesthesia: The procedure may be performed under local anesthesia with sedation or general anesthesia, meaning you may remain awake but sedated or elect to be fully sedated, and it is less invasive compared to surgeries requiring general anesthesia.
How Endoscopic Rhizotomy Works
Endoscopic rhizotomy works by targeting and disrupting the function of specific nerves that are responsible for transmitting pain signals from the facet joints to the brain. Here is how the procedure typically unfolds:
- Pre-Procedure Preparation: Before the procedure, you will have a consultation with your doctor, who will conduct diagnostic imaging tests such as X-rays, CT scans, or MRIs. These tests help identify the exact location of the pain and confirm that the facet joints are the source of your discomfort.
- Pre-Procedure Diagnostic Injections: Before the surgery will be considered, you will undergo diagnostic medial branch blocks in the office to confirm the surgical levels precisely.
- Anesthesia: The procedure is performed under anesthesia. You may elect to be awake but sedated or fully sedated to minimize discomfort during the procedure. A mild sedative is always given to help you relax.
- Insertion of the Endoscope: The surgeon makes a small incision (typically less than 1 cm per side) in the skin near the painful area. A thin tube (the endoscope) is inserted through this incision. The endoscope has a small camera at the tip, which allows the surgeon to see the targeted area in real time on a monitor.
- Targeting the Nerves: Using the endoscope as a guide, the surgeon carefully identifies the medial branch nerves that are transmitting pain signals. Once located, the surgeon applies radiofrequency energy or heat to the nerve to disrupt its ability to transmit pain signals to the brain. This is done with precision to avoid damaging surrounding tissues.
- Completion of the Procedure: After the treatment is completed, the endoscope is removed, and the incision is closed with surgical glue and a small bandage. Sutures are not always required, and the procedure typically lasts less than 60 minutes depending on the number of levels being treated.
Risks and Complications
While endoscopic rhizotomy is considered a safe procedure, it does carry some risks. These include:
- Infection: Any surgical procedure, even minimally invasive ones, carries a small risk of infection.
- Nerve Damage: Although rare, there is a risk that the heat or radiofrequency energy could affect nearby nerves, causing new or worsened symptoms.
- Incomplete Pain Relief: While many patients experience significant relief, not everyone responds to the procedure. In some cases, the pain may return over time or the procedure may not provide the level of relief anticipated.
- Bleeding or Hematoma: Although the procedure is minimally invasive, there is a small risk of bleeding or the formation of a hematoma (a collection of blood under the skin).
- Temporary Discomfort: Some patients may experience increased discomfort in the treated area for a short period after the procedure, although this typically resolves within a few days.
Recovery After Endoscopic Rhizotomy
One of the primary advantages of endoscopic rhizotomy is its relatively quick recovery time. Most patients experience only mild discomfort following the procedure, and many can return to normal activities within a few days. Here’s what you can expect:
- Post-Procedure Care: After the procedure, you will be monitored for a short time to ensure you’re recovering well from the anesthesia. Patients are able to go home on the same day of the procedure.
- Managing Pain: Some discomfort in the treated area is normal for the first few days, but this can typically be managed with over-the-counter pain medications or as prescribed by your doctor.
- Physical Activity: It is important to avoid strenuous physical activities, heavy lifting, or excessive twisting of the spine during the first few days of recovery. Your doctor will provide specific guidelines on when it’s safe to return to normal activities.
- Long-Term Relief: Many patients begin to experience pain relief within a few days to weeks after the procedure. It may take some time for the full effects to be felt, as the nerve disruption continues to reduce pain transmission.
- Follow-Up: You will have a follow-up appointment with your doctor to assess the effectiveness of the procedure and monitor your recovery. In some cases, additional treatments may be necessary if pain persists.
Long-Term Outcomes
The results of endoscopic rhizotomy can vary. For most patients, the relief from chronic pain lasts for years. Over time, some patients may require repeat procedures or additional levels treated if their symptoms return. However, the procedure is typically well tolerated and can provide significant long-term relief from pain, improving mobility and quality of life.
Contact EMISS to Schedule Your Procedure
Endoscopic rhizotomy is a minimally invasive procedure that offers significant relief for patients with chronic pain caused by facet joint dysfunction or other nerve-related pain in the spine. By targeting the specific nerves responsible for pain transmission, the procedure can provide long-term relief with minimal downtime. While it carries some risks, it is generally a safe and effective treatment for patients who have not found relief through other methods. If you are considering endoscopic rhizotomy, be sure to discuss the procedure with your doctor to determine if it’s the right option for your condition.
To learn how you can benefit from endoscopic rhizotomy and patient-centered care your spinal problems, call Endoscopic & Minimally Invasive Spine Specialists today, or book an appointment online.
