Indications and Outcomes with Endoscopic Posterior Cervical Rhizotomy

Axial neck pain without much radicular shoulder arm pain is a somewhat tricky situation for spine care providers. Patients often have the early-stage degenerative disease of the cervical intervertebral disc and facet joints, with minimal spinal alignment changes and without instability. Yet such patients may have legitimate symptoms and may have failed multiple rounds of physical therapy, spinal injections, activity modifications, non-steroidal anti-inflammatories, and other medical and supportive care measures. These patients may not fit traditional image-based spinal care protocols and are mostly left untreated. This chapter presents the authors' indications, and clinical outcomes with an endoscopically visualized combined mechanical and radiofrequency facet ablation with a minimal laminotomy at the symptomatic levels. They offer their rationale behind their strategies to attend to these patients with minimal cervical spine disease on advanced images but with unmanageable complaints who ordinarily have been falling into this watershed area of traditional spine care and reviewing possible pain relief mechanisms. The latter may be achieved not only by the combined mechanical and radiofrequency ablation of the cervical facet joint complex but also rely on modulation of the activity of the dorsal root ganglion of the cervical nerve root at the affected level. Outcomes are favorable in most patients, suggesting the authors' approach to treating these patients has merits; thus, warranting further clinical validation.

Keywords: Axial neck pain, Cervical spine, Decompression, Degeneration, Disc herniation, Endoscopic, Impingement, Minimally invasive, Open, Radiofrequency, Rhizotomy, Stenosis.