Transection of the Medial Branches Performed Endoscopically for Chronic, Axial Low Back Pain: A Case Report

Abstract

Background: Chronic, axial lower back pain is most commonly caused by either inflammation of the lumbar facet joints or arthritic changes at the joints. Chronic low back pain is the number one cause of missed work and disability in the working population. The scientific literature demonstrates that when the medial branches are targeted for treatment, patients typically exhibit positive results. Radio frequency ablations of the spine have been utilized for many years with mixed results which vary due to operator dependence. We present a case report on the surgical intervention of a patient treated by transection of the medial branches visualized endoscopically. Methods: Transection of the medial branches of an adult male with facet hypertrophy confirmed at L5-S1 under magnetic resonance imaging following successful medial branch blocks of the L4 medial branch and L5 primary dorsal ramus. Results: Following transection of the medial branches, the patient’s pain decreased in severity and quality at 1 week follow-up. He was no longer utilizing oral analgesics and noted that his persistent morning pain and stiffness had ceased causing him pain. We conclude that compared to radio frequency ablation, the patient did not exhibit post-operative discomfort and pain and demonstrated accelerated recovery and return to work status.