Endoscopic dorsal medial branch nerve rhizotomy: A systematic review.

Abstract

Chronic low back pain is a leading cause of disability worldwide, with lumbar facet joint syndrome accounting for a significant proportion of cases. While percutaneous radiofrequency ablation is the current standard of care for patients refractory to conservative therapy, endoscopic rhizotomy has emerged as a promising alternative with potential for improved precision and durability. This systematic review aims to evaluate the efficacy of endoscopic rhizotomy and compare the clinical outcomes with percutaneous ablation in the management of lumbar facet-mediated low back pain. A systematic literature review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Ovid were searched to identify studies evaluating endoscopic rhizotomy or directly comparing endoscopic rhizotomy to percutaneous ablation. Inclusion criteria encompassed prospective or retrospective cohort studies, randomized controlled trials, and case series reporting on postoperative outcomes. Primary outcomes included changes in pain scores, functional outcomes, need for repeat procedure, and adverse events. A total of 10 studies met inclusion criteria for analysis. Endoscopic rhizotomy demonstrated significant and sustained reductions in pain scores, with several studies reporting decreases of over 70 % maintained up to 24 months post-procedure. Comparative studies revealed that endoscopic rhizotomy was associated with greater pain relief and functional improvement than percutaneous ablation at nearly all follow-up intervals, including 6, 12, and 24 months. The rate of repeat interventions was lower in endoscopic rhizotomy cohorts compared to percutaneous ablation. Functional outcomes favored endoscopic rhizotomy with multiple studies showing 50 % or greater improvement from baseline. Endoscopic rhizotomy appears to be a safe and effective intervention for chronic lumbar facetogenic pain, offering longer-lasting pain relief and greater functional recovery than percutaneous ablation in selected patients.