Endoscopic facet joint treatment
The term „facet syndrome“ was introduced by Ghormley1 in 1933. Shealy2 proposed the use of percutaneous thermocoagulation for the denervation of facet joints in 1976. Based on this technique, Charles Ray and Nikolai Bogduk3,4 introduced radiofrequency neurolysis of the ramus medialis. In 1997, studies by Dreyfuss5 scientifically proved that targeted neurolysis of the ramus medialis can be used to treat pain emanating from the facet joint. The approach of endoscopically controlled radiofrequency facet joint denervation is likely to produce long-lasting pain relief6.
MultiZYTE®Facet can be used for several diagnostic and therapeutic procedures on the spine. These include periradicular therapy (PRT) and facet joint block. All surgery to the spine, including facet joint treatment, must be carefully prepared with a clinical diagnosis, magnetic resonance imaging (MRI) and/or computed tomography (CR), and various conventional X-ray images. Facet joint infiltration provides final verification of the facet joint level generating the pain. If pain stops after infiltration with painkillers, the corresponding nerve branch can be denervated using radiofrequency.
Treatment of the joint capsule
The joint capsule can also be treated during the same procedure depending on the indications. Under endoscopic view, the joint can either be punctured, infiltrated or tissue can be removed. Various instruments are available for this purpose (forceps, shaver blades, RF probes).
- Chronic lumbar back pain
- Facet joint hypertrophy
- Facet joint arthritis and osteoarthritis
- Post-discectomy syndrome
- Cervical spine trauma
When is the endoscopic facet joint treatment recommended?
- The patient has lumbar back pain that has persisted for more than six weeks and has not responded to conservative management
- Palpation of the facet joint triggers severe pressure pain and muscle spasms
- The patient has restricted movement in the lumbar spine, particularly when leaning back
- A block of the facet joint or medial nerve branch confirms that the facet joint is the source of the pain
Benefits of endoscopic facet joint treatment
- Small incision, therefore hardly any scar tissue
- Long-term therapy success thanks to the endoscopically controlled procedure
- Effective and targeted treatment using radiofrequency ablation
- Treatment of joint capsule with irrigation and vaporization
- Treatment at multiple levels possible with one incision
- Short recovery time
- Can be performed under local anesthesia
- Spinal mobility is preserved
1) Ghormley, RK.; Low back pain with special reference to the articular facets, with presentation of an operative procedure. JAMA.1933;101:773
2) Shealy CN.; Facet Denervation in the Management of Back and Sciatic Pain. Clin Orthop, 1976;115:157-164
3) Bogduk N.; Zygapophysial blocks and epidural steroids In: Neural Blockade in Clinical Anaesthesia and Management of Pain. 1988:935
4) Bogduk, N.; International Spinal Injection Society guidelines for performance of spinal injection procedures. Part 1: Zygapophysial joint blocks. Clin J Pain.1997;13:285–302
5) Dreyfuss P, Schwarzer AC, Lau P, Bogduk N. Specificity of lumbar medial branch and L5 dorsal ramus blocks. A computed tomography study. Spine. 15. April 1997;22(8):895–902
6) Haufe S. M. W. and Mork A. R.; Endoscopic Facet Debridement for the treatment of facet arthritic pain – a novel new technique Int. J. Med. Sci. 2010, 7
7) Yeung A et al. Endoscopic Dorsal Rhizotomy, a New Anatomically Guided MIS Procedure, Is More Effective than Traditional Pulsed Radiofrequency Lesioning for Non-discogenic Axial Back Pain. Poster 247, ISASS 2011