gms | German Medical Science

Introduction: The facet joint has been implicated as a source of chronic low back pain, especially in degenerative arthritis. The radiofrequency rhizotomy or cryotherapy of the dorsal nerve branches can provide pain relief. The result of the intervention is highly depended on surgeons experience and the positioning of the intervention needles. Anatomic structures were represented only indirectly by X-ray or ultrasound images. In contrast, endoscopy allows a controlled anatomical rhizotomy under direct visualization of the facet joints. Goal of this study is to describe the endoscopic technique, present our clinical experiences and analyse our results.

Methods: We performed endoscopic rhizotomy of the lumbar and sacroiliacal facet joints under general anesthesia in patients who have previously reported at least a pain relief of 50% on the numerical analogue scale (NAS) after infiltration test. We analyzed the surgical technique, the complications during and after intervention, and described advantages and disadvantages compared to other forms of rhizotomies described in the literature. Furthermore, the primary clinical outcome was specified in the relative difference, both at discharge and at the follow-up after 18 months.

Results: A total of 251 patients (158 women, 93 men; mean age 60.37 years; 26-87 years) were included. 1004 facets and 102 sacroiliacal joints were endoscopically thermo frequency coagulated. At discharge, 215 of 251 (85%) and at follow-up study 180 of 251 (72%) patients reported improvement in pain of >50% on the NAS. Complications were minimal and average surgical time per segment was 10 minutes.

Conclusion: Endoscopic rhizotomy of lumbar and sacroiliacal facet joints provided satisfactory results concerning pain control in patients with chronic lumbar back pain. Our preliminary results were very promising concerning the long-term outcome of relief in chronic lumbar back pain. However, further detailed long-term results need to be obtained in the future.