One of the major sources of nonradicular, lumbar back pain (in up to 30% of cases) is the posterior column of the spine and facet joints. Degenerative disease of the lumbar facet joints can occur naturally, but can aslo be hastened by previous spine surgery, including discectomy.

Facet mediated pain can be diagnosed when a medial branch block results in a greater than 50% improvement in back pain. Common treatments for facet oain include RF facet denervation and spinal fusion. In the RF facet denervation procedure, a needle is inserted percutaneously using a C-arm and a small RF probe is deployed to lesion the nerve. One drawback of this procedure, however, is the lack of a way to confirm that sufficient denervation has occured. Spinal fusion is a more definitive treatment for posterior column pain but is a significantly more invasive procedure that permanently alters the function of the spine.

Endoscopic Dorsal Ramus Rhizotomy takes the percutaneous RF facet denervation procedure an important step further by providing direct endoscopic visualization of the posterior spinal anatomy and nerves. A working channel in the Spine Endoscope allows passage of a specially designed RF probe so that thye surgeon may view the nerves as the probe locates and ablates the medial (and, optinally, the intermediate and lateral) branches of the dorsal ramus. The Endoscopic Dorsal Ramus Rhizotomy procedure offers a more aggressive alternative to percutaneous RF facet denervation, but one that is much less invasive and less traumatic than spinal fusion.

This video, scientific research and results are courtesy of respected Anthony Yeung, MD.