Endoscopic Sacrolumbar Facet Joint Denervation in Osteoarthritic and Degenerated Zygapophyseal Joints

Chronic low-back pain (CLBP) has an increasing incidence and yields a tremendous health economic burden. There are different anatomic structures that may be responsible for CLBP, such as lumbar intervertebral discs, sacroiliac joints, nerve root dura, fascia, ligaments, and muscles. However, to a large extent, CLBP is associated with structural changes in and around the facet (zygapophyseal) joint. If conservative treatment strategies fail, symptoms and pain can effectively be reduced by denervation or rhizotomy of the medial branch of the dorsal ramus of the spinal nerve through radiofrequency ablation. In this technical description with video, we present an endoscopic technique for radiofrequency rhizotomy. This technique has the advantage of directly visualizing the facet joint as well as its surrounding structures including the medial branches.