Procedure Description
Endoscopic medial branch nerve rhizotomy is an advanced, minimally invasive spine procedure used to treat chronic facet joint pain in the neck, mid-back, or lower back. It targets the medial branch nerves, which transmit pain signals from the small facet joints of the spine.
Unlike traditional radiofrequency ablation (RFA), this technique uses direct endoscopic visualization to identify and ablate the medial branch nerves with precision, reducing the risk of recurrence and preserving surrounding structures. It is often used when other conservative treatments have failed.
What It Treats
This procedure is specifically designed to treat chronic axial spine pain caused by:
Facet joint arthritis or hypertrophy
Facet-mediated low back, thoracic, or neck pain
Failed back surgery syndrome with facet involvement
Chronic neck or back pain not caused by disc herniation or nerve root compression
Patients typically have no leg or arm pain, as the medial branch nerves are non-motor sensory nerves responsible solely for transmitting pain from the facet joints.
How It Is Performed
The procedure is done in an outpatient surgical suite under local anesthesia with sedation or general anesthesia.
The patient is positioned depending on the spine level being treated (usually face down).
Using fluoroscopic X-ray guidance, a small incision (approximately 1 cm) is made near the spine.
A working channel and endoscope (tiny camera) are inserted, allowing the surgeon to visualize the medial branch nerve directly.
A specialized radiofrequency probe is used to ablate (burn) the nerve, effectively stopping pain transmission.
The instruments are removed and a single suture or adhesive strip is placed over the incision.
The procedure typically takes 30–60 minutes per side and is repeatable if needed in the future.
Pre-Procedure Instructions
Do not eat or drink for at least 6 hours prior to the procedure if sedation is used.
Continue taking prescribed medications unless advised otherwise. You may need to pause blood thinners several days in advance—please consult your provider.
Inform your physician if you:
Have allergies to anesthesia or contrast dye
Are pregnant or breastfeeding
Have had recent infection or illness
Arrange for a responsible adult to drive you home after the procedure.
What to Expect After the Procedure
You may experience mild soreness or discomfort at the incision site for a few days.
Some patients feel immediate relief, while others notice gradual improvement over 1–2 weeks as inflammation subsides.
Avoid heavy lifting or high-impact activity for a few days, but most patients return to light activity within 24–48 hours.
You may be referred to physical therapy to help restore spinal mobility and strength.
Pain relief can last 12 months or longer, with many patients reporting significant improvement in function and quality of life. The nerve may regenerate over time, but the procedure can be safely repeated if symptoms return.
Contact your provider if you experience:
Fever, chills, or signs of infection
New numbness, weakness, or leg/arm symptoms
Persistent bleeding or drainage from the incision
Evidence For Endoscopic Rhizotomy
Endoscopic medial branch nerve rhizotomy is supported by a growing body of evidence for the treatment of facetogenic chronic low back pain, particularly in patients refractory to conservative management. Randomized controlled trial data demonstrate that endoscopic neurotomy of the lumbar medial branch provides significant and durable pain relief, with superior outcomes at 6 months, 1 year, and 2 years compared to conventional radiofrequency neurotomy, as measured by improvements in VAS and Oswestry Disability Index scores. Additional prospective and retrospective studies confirm that endoscopic rhizotomy achieves greater pain relief and functional improvement than conservative therapy, with a favorable safety profile.[1-2]
Endoscopic techniques allow for direct visualization and targeted ablation of the medial branch nerves, potentially improving accuracy and reducing the risk of incomplete denervation or injury to adjacent structures. Narrative reviews and case series report pain relief in up to 80% of patients, with longer median pain-free intervals compared to traditional percutaneous radiofrequency ablation, though these findings are based on lower-level evidence and may be influenced by patient selection and procedural expertise.[3-5]
Current guidelines from the American Society of Pain and Neuroscience address radiofrequency neurotomy but do not yet specifically endorse endoscopic approaches due to limited high-quality comparative data.[6] However, the available literature suggests that endoscopic medial branch rhizotomy is a safe and effective option for selected patients with facet-mediated pain who have failed conservative measures and demonstrate a positive response to diagnostic medial branch blocks.[1][3]
At Parkview Pain & Regenerative Institute, we specialize in cutting-edge, minimally invasive procedures like endoscopic medial branch rhizotomy to treat chronic facet joint pain with precision and minimal downtime. If you’ve exhausted conservative options, this advanced technique may be the key to lasting relief.
👉 Schedule your consultation today to find out if endoscopic rhizotomy is right for you.
References:
Song K, Li Z, Shuang F, et al. World Neurosurgery. 2019;126:e109-e115.
2. Evaluation of Endoscopic Dorsal Ramus Rhizotomy in Managing Facetogenic Chronic Low Back Pain.
Li ZZ, Hou SX, Shang WL, Song KR, Wu WW. Clinical Neurology and Neurosurgery. 2014;126:11-7.
Streetman D, Fricker JG, Garner GL, et al. World Neurosurgery. 2023;169:36-41.
4. 3D Navigation of Endoscopic Rhizotomy at the Lumbar Spine.
Jentzsch T, Sprengel K, Peterer L, Mica L, Werner CML. Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia. 2016;23:101-105.
Huang SJ, Hsiao MC, Lee JH, Chen CM. Acta Neurochirurgica. 2022;164(5):1233-1237.
Lee DW, Pritzlaff S, Jung MJ, et al. Journal of Pain Research. 2021;14:2807-2831. Advanced Spine Care with Long-Term Relief