Safety and Effectiveness of the Endoscopic Rhizotomy for the Treatment of Facet-Related Chronic Low Back Pain

Lumbar spinal facet joints may be a significant source of chronic low back pain, with a reported prevalence of 7.7 to 75%. The clinical entity has been called facet joint syndrome. However, this syndrome and its therapies remain controversial as the clinical evidence for its treatment has been graded as weak. Intra- or periarticular injections have found acceptance as a diagnostic tool. Its etiology may be multifactorial, with degeneration of the joints’ cartilage being the likely leading cause. This process incites an inflammatory response involving the synthesis of proinflammatory cytokines and metalloproteinases. Hence, local injections of glucocorticoids into the affected joint has become an accepted short-term treatment option but with weak long-term benefit. In this chapter, the authors review their clinical experience with the endoscopic rhizotomy when treating chronic low back pain due to facet syndrome. Its safety and effectiveness were evaluated in 84 patients, including 48 females and 36 males with a mean age of 65, ranging from 52 to 82. Patients were included in the study if they reported greater than 80% pain relief with lumbar medial branch blocks using ropivacaine on two separate occasions. Primary clinical outcome measures were the VAS BACK score and the Oswestry Disability Index (ODI). There were no adverse events and complications except one patient with a postoperative hematoma, which resolved with conservative care. At the final six months follow-up, the VAS scores were significantly lower (postop VAS 2.3; range 0 - 4) than before endoscopic rhizotomy (preop VAS mean 6.4; range 4-7; p < 0.05). The postoperative ODI of 24 (range 12 - 48) was significantly lower than its preoperative value 52 (range 42-67). The authors conclude that dorsal endoscopic rhizotomy is safe and effective for facet-related low back pain.

Keywords: Low back pain, Lumbar facet pain, Neurectomy, Rhizotomy.