14. 10. 2016
An endoscopic rhizotomy (endoscopic denervation of the facet joints) is an operation intended for patients suffering from chronic pain of the lumbar spine caused by inflammation or osteoarthritis. We present an innovative solution for the facet syndrome using an endoscopic technique.
Knowledge of the issue of facet joints is absolutely essential for anyone who is involved in the diagnosis of back pain at a comprehensive level. To exclude or confirm the facet joint as the originator of pain, we use a precision media branch block of the spinal nerves under X-ray navigation as standard. According to the best practices from the Spine Intervention Society (SIS), to confirm the diagnosis of facet syndrome a series of two positive test blocks is required in order to reduce the risk of a false positive or a false negative response to the test. In the case of a positive test result, we recommend radio-frequency denervation of the facet joints to the patient, which is carried out using a special electrode placed close to the nerve and we thermally coagulate this nerve.
The conventional technique that has been used around the world for decades has certain limitations that reduce the effectiveness of the treatment. X-ray navigation does not allow a check to be made that the electrode has actually been located near the nerve and it is likewise impossible to visualise the actual interruption of the nerve.
At our workplace we are intensively involved in endoscopic techniques in the spinal canal, so we decided to use the endoscopic equipment on our patients, for whom it is suitable, to interrupt the nerves of the innervating facet joints. The endoscopic technique allows us to directly visualise the neural structure and the interruption of the nerve is carried out under direct visual inspection.
In our opinion, the use of endoscopic techniques during the innervation of the facets increases the efficiency of this treatment method, which we will try to prove by an analysis of the clinical data of our patients, which is carefully collected pursuant to the study protocol approved by the Ethics Committee. We are aware that the method is financially very demanding and likewise we require a surgeon with the ability to perform routine endoscopic operations in the spinal structures.
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