hello my name is Kevin McCarthy I'm a minimally invasive spine surgeon at the
spine center of Baton Rouge and today I'm going to be talking about a
minimally invasive treatment for low back pain so in the lower back we have a
series of small joints called the facet joints and you can see them here on this
month these small joints move as the back
moves and stabilize the spine similar to other joints in the body such as the
knee and hip these joints can become inflamed and painful and when they do
they cause lower back pain and oftentimes the lower back pain can be
excruciating typically facet related back pain is
worse when the patient extends the back arches back or when they stand from a
sitting position common treatments for facility pain initially include
medication physical therapy and at times injections in this first diagram we see
the distribution of pain that patients typically experience from the facet
joints and as you can see facet joint pain could cause pain in the lower back
all the way down to the buttocks and upper thighs the next diagram shows the
anatomy of the facet joint and you can see a small branch of the large nerve
comes off and attaches to the facet joint and this is the medial branch
nerve that tells the brain that these facet joints are hurting and this
specific tiny little nerve can be targeted with procedure of treatments
this next diagram again shows a treatment that targets this medial
branch nerve as it branches off from the large and organ attaches to the facet
joint in this case the nerve is being targeted and burned through a heating
probe so patients that present with low back pain and it's thought to be related
to their facet joints we confirm that with a diagnostic injection that's a
procedure where we inject a tiny bit of numbing medication right around that
nerve and if the patient's back pain goes away we know that the pain is
coming from this joint in patients that have relief with that diagnostic
injection they are candidates for a minimally invasive procedure targeting
that small little nerve and that's called a rhizotomy procedure
now traditionally rhizotomies have been done through a traditional percutaneous
technique using just a needle now this is a procedure where a needle is placed
down to the area where the nervous thought to be based on the anatomy
knowledge and a heat probe is placed through that needle and it's raised to a
certain temperature to allow us to burn that nerve the problem with this
procedure is you're not specifically seeing the nerve or confirming that
you're getting that nerve so there's some failure rate to this procedure a
newer technique that's used through a minimally invasive fashion is an
endoscopic rhizotomy no endoscopic procedures are done using
a scope similar to what we use in a shoulder scope or a knee scoped it
allows us to put the camera into the spine through a tie no a poke incision
and look and actually find that little nerve that's going to the central so
under direct visualization using a radio frequency probe or a laser we can burn
that nerve under direct visualization and know that we're definitely getting
the targeted nerve that we're going after and through through that process
we're able to take away the pain that's coming from that facet joint and give
patients that have back had had back pain for years relief so in this live
video of an actual procedure we can see the nerve actually being burned under
direct visualization severing the nerve and half disrupting that communication
of pain to the brain as a result this patients back pain would be markedly
improved or drawn I've been performing this procedure at the spines that are in
Baton Rouge for greater than ten years the endoscopic rhizotomy is a minimally
invasive procedure that's an improvement on a traditional technique patients have
done very well we've had great outcomes in appropriately selected patients if
you'd like to know more information about the endoscopic rhizotomy procedure
check our website for information or call and make an appointment in coming
discussing it