We present a detailed description of the surgical technique and the preliminary results of an endoscopic
denervation for patients with chronic
low back pain (CLBP) originating from the facet joints (FJ). Endoscopic
denervation of the medial branches of the dorsal rami supplying the FJ has recently been appraised as providing excellent intraoperative visualization and long term
pain relief for these patients. Conventional endoscopic
rhizotomy has been expanded to include a the precise localization of 3D navigation. A surgical description and the results of our first four patients treated with 3D navigated endoscopic
rhizotomy (3DNER) are presented. Four patients with a mean age of 59years and a follow-up time of 2months were included. All patients reported
pain reduction in the immediate postoperative period, while three patients (75%) had long lasting relief. The patient without persisting relief had previously sustained a lumbar disc
prolapse and only achieved minor
pain relief with preoperative FJ infiltration, compared to the significant relief that was seen in the other patients. In contrast to conventional
rhizotomy, 3DNER enables the surgeon to ablate more precisely and extensively, which is especially useful if
scar tissue is present from previous
injuries or surgeries. When successful, this technique may provide long lasting
pain relief, especially if the preoperative FJ infiltrations are followed by a substantial
pain reduction.