The facet joints of the lumbar spine are responsible for controlling motion and providing stability to the lower back. These small articulations can develop arthritis and inflammation similar to the hip, knee and other larger joints in the body. The facets are thought to be responsible for low back pain in up to 40% of cases. The facet joints are innervated by a small medial branch of the spinal nerve. This nerve is responsible for transmitting the sensation of pain from the facet back to the brain. In patients with suspected facet related pain, the medial branch has historically been targeted with a rhizotomy. This procedure has been classically done by pain management doctors. A probe is inserted percutaneously with X-ray guidance to the area where the nerve is thought to be located based on anatomic relationships. The probe is then heated and wanded back and forth with the hope of ablating the nerve and relieving the pain. However, this blind technique can have its limitations and failures, and recurrence rates can be high. When this procedure is successful, patients can experience relief of their lower back pain up to 12-18 months.
The Spine Center at the Bone and Joint Clinic of Baton Rouge has been performing a new and innovative procedure for facet related back pain. Patients are diagnosed with this condition through a physical examination, radiographic studies and a confirmatory medial branch block injection. Appropriate patients are considered for the endoscopically assisted medial branch rhizotomy.
During this procedure, an endoscope is inserted percutaneously and the medial branch nerve is located with direct visualization. The endoscope has a unique working channel through which special instruments such as a laser or radiofrequency probe can be inserted. Using these instruments, the medial branch nerve can then be ablated under direct visualization. It is theorized that this procedure will allow more accurate targeting of this nerve and thus more predictable and lasting results than the more common blind medial branch rhizotomy. This procedure has been performed with great success at the Bone and Joint Clinic since 2009. The Spine Center is currently enrolling patients in a clinical study to collect comparative data on the effectiveness of this new technique.