Facet Joint Denervation
The small vertebral joints (facet joints) are surrounded by a dense network of nerve fibers. These are irritated by inflammatory processes which occur as part of arthrosis. Direct mechanical irritation is also possible as a result of instability.
Primary symptoms are therefore back pain or neck pain without significant radiating pain and without neurological deficits. The pain is conducted along the medial branches of the dorsal ramus of the spinal nerve. The objective of endoscopic denervation is to selectively transect these nerve fibers in order to permanently interrupt the conduction of pain.
The denervation procedure starts with a needle targeting the transverse process under fluoroscopy. A dilator and working sleeve are inserted, and a shorter spine endoscope is used to visualize the path of the medial branch of the dorsal ramus. Rongeurs and a TipControl RF electrode are used to cut and coagulate the medial branch under endoscopic visualization. This is repeated at as many levels as is required for sufficient pain relief.
Sacroiliac Joint Denervation
In addition to the facet joints, the sacroiliac joint (SIJ) is frequently a generator of back pain. The mechanisms are similar to those for the facets. The sacroiliac syndrome frequently occurs after stabilization of the spine because the sacroiliac joint is subject to a greater load and this in turn leads to mechanical and inflammatory irritations of the nerves at this joint.
A technique similar to the facet joint denervation can be used, except the targeted branches of the dorsal rami are at the S1-S3 levels where they exit the sacrum. The same instruments are used as for the facet denervation.
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