Lumbar endoscopic medial branch transection, or rhizotomy, is a procedure used to treat chronic lower back pain that is often caused by facet joint arthritis or other degenerative spinal conditions. The procedure targets the nerves responsible for transmitting pain signals from the facet joints in the lumbar (lower) spine.

The facet joints are small joints located on the back of each vertebra. They allow for movement and stability of the spine but can become damaged or inflamed due to injury, aging, or wear and tear. This damage can lead to chronic pain, stiffness, and reduced mobility.

In rhizotomy, a spine surgeon uses a small endoscope to access the medial branch nerves that supply the facet joints. Using advanced imaging techniques like fluoroscopy (real-time X-ray), the surgeon directly visualizes delivers a precise electrical impulse or heat (radiofrequency energy) to sever these nerves, disrupting their ability to send pain signals to the brain.

• Preparation: The patient is typically placed under general anesthesia and, in some cases, light sedation. The procedure is performed on an outpatient basis, meaning the patient can go home the same day.
• Accessing the Nerves: A small incision, a blunt dilator is placed gently through the muscle to the transverse process bone, adjacent to the facet joint in the spine. The surgeon inserts the endoscope, a thin tube equipped with a camera, to visualize the medial branch nerves. X-ray guidance is used throughout the procedure to ensure precision.
• Nerve Disruption: Once the nerve is located, the surgeon uses a radiofrequency device to apply heat to the nerve. This heat severs the medial branch nerve and disrupts the nerve's ability to send pain signals, effectively “shutting off” the pain without damaging the surrounding tissues.
• Recovery: Because the procedure is ultra-minimally invasive, recovery times are typically short. Most patients experience some discomfort after the procedure, but this usually resolves within a few days. Patients may be instructed to avoid strenuous activities for a short period to allow healing.