Patients who fail conservative treatment may benefit from x-ray directed facet joint injections
or burning the facet nerve
(radio frequency ablation
of the medial branch nerve). Unfortunately these treatments only last 3 to 6 months on average. As a consequence many people consider surgery.
Traditionally patients required fusion
surgery. Fusion surgery usually involves large skin incision
, significant muscle retraction and damage, bone removal
and the placement of metal screws and rods. Collateral tissue damage from the surgery may result in more pain, back muscle weakness
, instability and scar tissue leading to future difficulties.
Fortunately this surgery can now be done minimally invasive through 1 inch incision. The surgery is done through a tube in between back muscles to decrease muscle damage and weakness caused by muscle retraction.
The most recent advance in spine surgery is the development of endoscopic spine surgery
. Endoscopic spine surgery is state-ofâ€”the-art minimally invasive spine surgery. A micro video camera is inserted through a very small incision to the damaged facet joints. The camera projects the images onto a video screen so the surgeon can easily visualize find the painful facet nerve. Tiny instruments are inserted through the camera to cut the pain nerve under direct visualization. Back pain usually rapidly improves. This is called endoscopic rhizotomy
The advantages of endoscopic rhizotomy include:
no general anesthesia
very small incisions
less post operative pain