Lumbar Spine

Safety and Effectiveness of the Endoscopic Rhizotomy for the Treatment of Facet-Related Chronic Low Back Pain

Author(s): Ralf Rothoerl*, Stefan Hellinger, Anthony Yeung and Kai-Uwe Lewandrowski

Pp: 200-220 (21)

DOI: 10.2174/9789815051537122020014

* (Excluding Mailing and Handling)

Abstract

Lumbar spinal facet joints may be a significant source of chronic low back pain, with a reported prevalence of 7.7 to 75%. The clinical entity has been called facet joint syndrome. However, this syndrome and its therapies remain controversial as the clinical evidence for its treatment has been graded as weak. Intra- or periarticular injections have found acceptance as a diagnostic tool. Its etiology may be multifactorial, with degeneration of the joints’ cartilage being the likely leading cause. This process incites an inflammatory response involving the synthesis of proinflammatory cytokines and metalloproteinases. Hence, local injections of glucocorticoids into the affected joint has become an accepted short-term treatment option but with weak long-term benefit. In this chapter, the authors review their clinical experience with the endoscopic rhizotomy when treating chronic low back pain due to facet syndrome. Its safety and effectiveness were evaluated in 84 patients, including 48 females and 36 males with a mean age of 65, ranging from 52 to 82. Patients were included in the study if they reported greater than 80% pain relief with lumbar medial branch blocks using ropivacaine on two separate occasions. Primary clinical outcome measures were the VAS BACK score and the Oswestry Disability Index (ODI). There were no adverse events and complications except one patient with a postoperative hematoma, which resolved with conservative care. At the final six months follow-up, the VAS scores were significantly lower (postop VAS 2.3; range 0 - 4) than before endoscopic rhizotomy (preop VAS mean 6.4; range 4-7; p < 0.05). The postoperative ODI of 24 (range 12 - 48) was significantly lower than its preoperative value 52 (range 42-67). The authors conclude that dorsal endoscopic rhizotomy is safe and effective for facet-related low back pain.


Keywords: Low back pain, Lumbar facet pain, Neurectomy, Rhizotomy.

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      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51435153 and j.to_ip >=51435153 )) and ((j.from_date <= 1739988510 and j.to_date >= 1739988510 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16886) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51435153 and j.to_ip >=51435153 )) and ((j.from_date <= 1739988510 and j.to_date >= 1739988510 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16886) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51435153 and j.to_ip >=51435153 )) and ((j.from_date <= 1739988510 and j.to_date >= 1739988510 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16886)
      820μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 3335 and `b`.`banner_from_date` <= 1739988510 and `b`.`banner_to_date` >= 1739988510 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.45msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 3335
      • 3: 1739988510
      • 4: 1739988510
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='357f31cf10355b2d7a1f8bb46a811206'
      260μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    4Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        SwiajckacjccrrNk29CFmG5rOhdG62wDNqHY6EJk
        uc_cart_id
        357f31cf10355b2d7a1f8bb46a811206
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/16886" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/16886
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6IjVWYXJGalZGaWpMVmlrQVQwVDRWNUE9PSIsInZhbHVlIjoiRm9Vc2VCdjBOUFBRcVlrdHJkWlpNQmY3S3QwL3F3eTdYMUNZTDZpeS9Mbz0iLCJtYWMiOiJkYWNjNzc0OWRkZjIwMThiOWU1ODhjMWVkNGE5Y2Q3Y2ZkNjg4M2U4ZGFiNmY2MTMxOWNjZDY2ZDZmNTcwNzE3IiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6IjVWYXJGalZGaWpMVmlrQVQwVDRWNUE9PSIsInZhbHVlIjoiRm9Vc2VCdjBOUFBRcVlrdHJkWlpNQmY3S3QwL3F3eTdYMUNZTDZpeS9Mbz0iLCJtYWMiOiJkYWNjNzc0OWRkZjIw" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Wed, 19 Feb 2025 18:08:30 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IlBwcXRzdU5OYzNHUE43RGh6YWhWbHc9PSIsInZhbHVlIjoidysxdjd4a29CM2ltTFZMQ0pWcDlRcEM2bHYrcXQ3NTAvdktKNkRCRGlQTDQreW5yL0lidHFBTDc5ZHlhT0ZwRk5jNHBlSXhmckN6dUxaa0ZDU3ppRktWSXFMOEJLWUlpeWlwVHF2VzRuMFNFRFBkazM2S1llNzAweVl1QllEb2UiLCJtYWMiOiIxMTFmOWMxMGEyNTA4MmRiMGVkYzliZjkzMDk1MjIzZjAxMmU4YTQxYWU2MzMwNjRiNWNlZDE5NTJmYjkyM2NmIiwidGFnIjoiIn0%3D; expires=Sat, 22 Feb 2025 06:08:30 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IlBwcXRzdU5OYzNHUE43RGh6YWhWbHc9PSIsInZhbHVlIjoidysxdjd4a29CM2ltTFZMQ0pWcDlRcEM2bHYrcXQ3NTAvdktKNkRCRGlQTDQreW5yL0lidHFBTDc5ZHlhT0ZwRk5jNHBlS" 1 => "alphaeurekaselectnet_session=eyJpdiI6ImtSWnJLL042YWpIc3B4NjN6VWs4Q2c9PSIsInZhbHVlIjoiMG9DWm5jL0IwOVpTNm1aaHJHbDl6TVBsdXYrNlFhOVBsQXFPNllNUy92TEF3aEM4NFZPc0gvc3Uza3UvV052WU53ZENoakFaN0ExOHJESDRUSVh2ckFBVlg3dFpqa2lTWEJ6bnNHOEc0S3Jpb0ZWVVd3dUtlQXhIRW1OYXBwRWkiLCJtYWMiOiI4NTczZjczODU2NDg3YmVmMDI2MmZmNWIwNzk1ZDRmYjkxZDVlNzUxNThmMzcwZGYwYTUzYTA2ZDkyZGZiZjUyIiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6ImtSWnJLL042YWpIc3B4NjN6VWs4Q2c9PSIsInZhbHVlIjoiMG9DWm5jL0IwOVpTNm1aaHJHbDl6TVBsdXYrNlFhOVBsQXFPNllNUy92TEF3aEM4NFZPc0gvc3U" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IlBwcXRzdU5OYzNHUE43RGh6YWhWbHc9PSIsInZhbHVlIjoidysxdjd4a29CM2ltTFZMQ0pWcDlRcEM2bHYrcXQ3NTAvdktKNkRCRGlQTDQreW5yL0lidHFBTDc5ZHlhT0ZwRk5jNHBlSXhmckN6dUxaa0ZDU3ppRktWSXFMOEJLWUlpeWlwVHF2VzRuMFNFRFBkazM2S1llNzAweVl1QllEb2UiLCJtYWMiOiIxMTFmOWMxMGEyNTA4MmRiMGVkYzliZjkzMDk1MjIzZjAxMmU4YTQxYWU2MzMwNjRiNWNlZDE5NTJmYjkyM2NmIiwidGFnIjoiIn0%3D; expires=Sat, 22-Feb-2025 06:08:30 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IlBwcXRzdU5OYzNHUE43RGh6YWhWbHc9PSIsInZhbHVlIjoidysxdjd4a29CM2ltTFZMQ0pWcDlRcEM2bHYrcXQ3NTAvdktKNkRCRGlQTDQreW5yL0lidHFBTDc5ZHlhT0ZwRk5jNHBlS" 1 => "alphaeurekaselectnet_session=eyJpdiI6ImtSWnJLL042YWpIc3B4NjN6VWs4Q2c9PSIsInZhbHVlIjoiMG9DWm5jL0IwOVpTNm1aaHJHbDl6TVBsdXYrNlFhOVBsQXFPNllNUy92TEF3aEM4NFZPc0gvc3Uza3UvV052WU53ZENoakFaN0ExOHJESDRUSVh2ckFBVlg3dFpqa2lTWEJ6bnNHOEc0S3Jpb0ZWVVd3dUtlQXhIRW1OYXBwRWkiLCJtYWMiOiI4NTczZjczODU2NDg3YmVmMDI2MmZmNWIwNzk1ZDRmYjkxZDVlNzUxNThmMzcwZGYwYTUzYTA2ZDkyZGZiZjUyIiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6ImtSWnJLL042YWpIc3B4NjN6VWs4Q2c9PSIsInZhbHVlIjoiMG9DWm5jL0IwOVpTNm1aaHJHbDl6TVBsdXYrNlFhOVBsQXFPNllNUy92TEF3aEM4NFZPc0gvc3U" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "SwiajckacjccrrNk29CFmG5rOhdG62wDNqHY6EJk" "uc_cart_id" => "357f31cf10355b2d7a1f8bb46a811206" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/16886" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-19 18:08:30GET/chapter/16886112196