Percutaneous Endoscopic Median Branch Avulsion

What is a percutaneous endoscopic median branch nerve avulsion?

Percutaneous means surgery is performed through a needle puncture, instead of a large skin incision. The use of a needle allows the surgeon to access the nerve without a large incision through skin and important back muscles. Once the needle is in place it is exchanged for a small tube that allows an endoscope to pass through it. Endoscopic means that the surgeon performs the procedure through a channel in the endoscope, while watching with the endoscope camera. The median branch is a nerve that carries painful signals from the spine joints. The avulsion procedure is a minimally invasive way to relieve spine joint pain by cutting the median branch nerve.

How is an endoscopic median branch nerve performed?

A median nerve avulsion is a minimally invasive procedure for back pain resulting from arthritis of the joints of the spine, known as the facet joints. The procedure is performed after previous injection procedures have confirmed that the facet joint is the cause of pain. A needle is directed to the nerve that carries nerve signals from the inflamed facet joint. The needle is exchanged for a small tube. Using specialized instruments through the tube the nerve transmitting painful signals is cut.

What are the advantages of percutaneous endoscopic median branch nerve avulsion?

Because a needle is used to access the nerve from the skin a skin incision is not made, only a skin nick. The lack of an incision means healthy muscle is not disrupted. Performing surgery through a tiny skin nick and leaving healthy tissues intact means a same day procedure with a quicker recovery. A percutaneous median branch avulsion has several distinct advantages compared to other procedures to treat back pain:

  • A median branch avulsion lasts much longer than a rhizotomy procedure, and may even be permanent.
  • A median branch avulsion may be as effective as spinal fusion in treating back pain, while being far less invasive and allowing a far quicker recovery.

How long will the procedure take?

The procedure typically takes an hour to an hour and a half, depending on how many levels are operated on. After the procedure you will recover for about two hours before going home.

What is the recovery like?

Patients walk out the door and go home the same day with pain medications. We advise no strenuous physical activity or heavy lifting for 2 to 3 days. After that, patients can resume work and usual activities. Physical therapy and chiropractic care can be resumed immediately.

The 4 Pillars of Treating Chronic Spinal Pain

George Rappard MD discusses the 4 key pillars of spine care. The 4 pillars are physical therapy and chiropractic care tailored to your condition, appropriate selection of medical therapy, pain injections targeting your specific pain source and, as a last result, minimally invasive motion and stability preserving spinal surgery performed as an outpatient procedure. Through effective use of the first 3 pillars only about 5% of our patients need to go on to have back surgery or neck surgery.

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