What is Endoscopic Neurotomy for Back Pain?
Endoscopic neurotomy for back pain is a minimally invasive procedure that uses an endoscope (a small camera and surgical tool) to sever or ablate (destroy) pain-causing nerves in the spine. This technique is commonly used to treat chronic back pain caused by facet joint arthritis or sacroiliac joint dysfunction.
Indications for Endoscopic Neurotomy for Back Pain
Endoscopic neurotomy for back pain is typically recommended for:
- Patients with chronic back pain due to facet joint syndrome or sacroiliac joint dysfunction.
- Those who had successful temporary relief from a diagnostic nerve block.
- Individuals who do not respond to conservative treatments (physical therapy, medications, injections).
Procedure for Endoscopic Neurotomy for Back Pain
Endoscopic neurotomy for back pain is typically performed on an outpatient basis and generally involves the following steps:
- The patient is positioned prone (face down) on the procedure table.
- The surgical site is cleaned (typically the lower back) and sterilized to minimize infection risk.
- Local anesthesia and mild sedation are administered to keep the patient comfortable.
- A small skin incision (about 5 mm) is made near the affected spinal level.
- A dilator and working cannula are inserted under fluoroscopic (X-ray) guidance to reach the nerve.
- A specialized endoscope (camera-assisted tube) is introduced through the cannula to visualize the target nerve.
- Using real-time endoscopic visualization, the surgeon precisely locates the small medial branch nerves (for facet joints) or lateral branch nerves (for sacroiliac joints) responsible for pain transmission.
- The nerve is ablated using one of the following methods:
- Radiofrequency Ablation (RFA) – High-frequency electrical current generates heat to disrupt the nerve.
- Laser Ablation – A laser fiber is used to coagulate and sever the nerve.
- Mechanical Resection – A small rotating shaver or electrocautery tool physically removes the nerve tissue.
- The procedure prevents the nerve from transmitting pain signals while preserving surrounding structures.
- The endoscope and instruments are removed, and the incision is closed with a small adhesive strip or suture. A sterile bandage is applied.
Post-Procedure Care
After an endoscopic neurotomy for back pain, patients are monitored for a short period before being discharged the same day. Mild soreness at the incision site is common, and ice packs can help reduce swelling. Light activities can usually be resumed within a few days, but strenuous activities and heavy lifting should be avoided for at least 2-4 weeks. Pain relief may take a few days to a few weeks to fully develop as inflammation subsides. Patients should follow up with their doctor to assess progress and may be advised to participate in physical therapy to strengthen the back and prevent future pain. Over-the-counter pain relievers or prescribed medications can help manage discomfort during recovery.
Risk and Complications
Endoscopic neurotomy for back pain is generally a safe procedure with a low risk of complications. However, like any medical intervention, it carries potential risks, such as:
- Temporary pain or discomfort
- Temporary numbness or weakness
- Mild swelling or bruising
- Burning or tingling sensation
- Infection or bleeding
- Scarring or adhesions
- Nerve damage (rarely)
Benefits
Benefits of endoscopic neurotomy for back pain include:
- Minimally Invasive – Small incisions and reduced trauma
- Outpatient Procedure – Most patients go home the same day
- Faster Recovery – Less downtime compared to traditional surgery
- Effective Pain Relief – Can provide long-lasting relief for chronic back pain
- Lower Risk of Complications – Reduced risk of infection and scarring
- Precision - Direct visualization of the nerve allows for more accurate treatment