Ablation of medial bundle branch under spinal endoscopy

Abstract

This chapter identifies the advantages and techniques of radiofrequency ablation of the medial bundle branch (MBB) under spinal endoscopy in patients suffering from chronic low back pain. Although the intra-articular injection and MBB block with steroids are easy-to-perform, non-surgical procedures with additional diagnostic values, patients may experience symptom recurrence due to shorter duration of relief, and there are always risks of possible local and systemic complications associated with repeated steroid injections. Continuous radiofrequency and pulsed radiofrequency lesioning of the medial branch of the dorsal ramus, an interventional surgical technique to treat facet-mediated axial back pain, is a current method utilised in pain management for the treatment of chronic lumbar back pain. First described by Shealy in 1975, it involves using energy in the radiofrequency range to perform necrosis of specific nerves (medial branches of the dorsal rami in patients with lumbar facetogenic pain), avoiding the neural transmission of pain. Although steroid infiltrations do provide good long-term relief, the occasional variation in anatomy due to the individual changes or advanced degenerative process can be overcome by direct visualisation under the endoscope. This focussed endoscopic lesioning also avoids extensive scar formation which may occasionally lead to recurrence of low back pain.