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How I do it? Full endoscopic lumbar rhizotomy for chronic facet joint pain due to failed back surgery syndrome

  • How I Do it - Spine - Other
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Abstract

Background

Failed back surgery syndrome (FBSS) is a general term for persistent postoperative back pain with or without accompanying radicular pain. FBSS may present as chronic facet joint pain.

Methods

We introduced full endoscopic lumbar rhizotomy for patients suffering from facet joint pain due to FBSS. Facet joint block was introduced into the facet joint to determine whether pain improved after the injection.

Conclusion

With full endoscopic lumbar rhizotomy, the surgeon can identify the regions involved more clearly and directly. Although it is an invasive procedure, it provides a more effective and safe treatment for patients with FBSS-related facet joint pain.

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Acknowledgements

We thank Anna D (www.enago.tw) for her expertise and assistance throughout all aspects of our study and for her help in writing the manuscript.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, No 135 Nanhsiao Street, Chuanghua City, 50006, Taiwan

    Sheng-Jia Huang, Jae Hwan Lee & Chien-Min Chen

  2. Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung City, 40705, Taiwan

    Mei-Cheng Hsiao

  3. College of Nursing and Health Sciences, Dayeh University, Changhua City, Taiwan

    Chien-Min Chen

  4. School of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan

    Chien-Min Chen

Authors
  1. Sheng-Jia Huang
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  2. Mei-Cheng Hsiao
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  3. Jae Hwan Lee
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  4. Chien-Min Chen
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Contributions

Writing—original draft preparation: S-JH and M-CH. Writing—review and editing: JHL. Supervision: C-MC.

Corresponding author

Correspondence to Chien-Min Chen.

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Conflict of interest

The authors declare no competing interests.

Disclosure

The corresponding author is the director of the Taiwan Society of Minimally Invasive Spine Surgery.

Additional information

Key points

1. Chronic facet joint pain is a potential cause of FBSS. Improved low back pain after facet joint block may help in the diagnosis.

2. Each facet joint is innervated by the medial branch from two adjacent dorsal rami that runs tightly at the lateral border of the superior articular process of the lower vertebra, then enters the fibro-osseous canal under the mamillo-accessory ligament.

3. The indication for full endoscopic lumbar rhizotomy requires that the patient was diagnosed with facet joint syndrome and experienced treatment failure after a 6-week conservative treatment.

4. With the navigation guidance system, the operator can confirm the insertion at the correct position safely and efficiently.

5. The incision is determined at the root of the lumbar transverse process, then the obturator-working cannula composite is placed through the incision toward the fibro-osseous canal.

6. While the median branch is visible through the endoscope, the endoscopic punch is used to cut the nerve.

7. If the median branch could not be visualized due to scar tissue from a previous operation, additional portions of the surrounding soft tissue and nerve stump involved by pedicle screws need to be removed.

8. The end point of the operation was to check the triggered pain by pressing on the spot immediately over the facet joint to confirm low back pain relief as reported by the patient.

9. After the operation, the patient can ambulate immediately.

10. The medial branch still innervates the multifidus muscles that contribute to lumbar stability. Postoperative low back pain may still occur if standing for long periods. Referred to the rehabilitation outpatient care for muscle reinforcement may be considered after the surgery.

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Huang, SJ., Hsiao, MC., Lee, J.H. et al. How I do it? Full endoscopic lumbar rhizotomy for chronic facet joint pain due to failed back surgery syndrome. Acta Neurochir 164, 1233–1237 (2022). https://doi.org/10.1007/s00701-021-05042-4

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  • DOI: https://doi.org/10.1007/s00701-021-05042-4

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