title: Evaluation of endoscopic dorsal ramus rhizotomy in managing facetogenic chronic low back pain.
abstract: OBJECTIVE
  To study the effectiveness of surgical dorsal endoscopic rhizotomy for the treatment of facetogenic chronic low back pain.
  
  
  METHODS
  From April 2011 to November 2011, 58 patients who were diagnosed with lumbar facetogenic chronic low back pain (CLBP) and thereafter experienced >80% reliefs of pain with two comparative lumbar medial branch blocks were recruited in the study. Of those 58 patients, 45 cases (the operation group) received dorsal endoscopic rhizotomy, and the remaining 13 cases (the conservative group) received conservative treatment. Patients' preoperative and postoperative VAS score, percentage of pain relief and the MacNab score were analyzed and compared. Anatomic variations and any possible complications were recorded.
  
  
  RESULTS
  In the operation group, VAS scores of pain (low back/referred) at any time point postoperatively were significantly lower than that before MBB (P<0.05), which, however, showed no significant difference as compared to the scores after MBB (P>0.05). In the conservative group, VAS scores of pain (low back/referred) at any time point postoperatively with conservative treatment decreased significantly compared with that before MBB (P<0.05) and were significantly higher than that after MBB (P<0.05). Percentage of pain relief in the operation group at any time point postoperatively were significantly higher than that in the conservative group (P<0.01). The MacNab scores of 1 year follow-up in the operation group were higher than that in the conservative group. In addition, four separate newly identified anatomical variations of medial branch anatomy were observed and reported.
  
  
  CONCLUSIONS
  Dorsal endoscopic rhizotomy is safe and effective for the facetogenic CLBP, and can achieve better clinical outcome than the conservative treatment.
authors.affiliation: Department of Orthopedics Surgery, the First Affiliated Hospital of Chinese PLA General Hospital, Beijing, China. Electronic address: lizhenzhou88@126.com.
authors.forename: Zhen-Zhou
authors.initials: ZZ
authors.lastname: Li
authors.affiliation: Department of Orthopedics Surgery, the First Affiliated Hospital of Chinese PLA General Hospital, Beijing, China.
authors.forename: Shu-Xun
authors.initials: SX
authors.lastname: Hou
authors.affiliation: Department of Orthopedics Surgery, the First Affiliated Hospital of Chinese PLA General Hospital, Beijing, China.
authors.forename: Wei-Lin
authors.initials: WL
authors.lastname: Shang
authors.affiliation: Department of Orthopedics Surgery, the First Affiliated Hospital of Chinese PLA General Hospital, Beijing, China.
authors.forename: Ke-Ran
authors.initials: KR
authors.lastname: Song
authors.affiliation: Department of Orthopedics Surgery, the First Affiliated Hospital of Chinese PLA General Hospital, Beijing, China.
authors.forename: Wen-Wen
authors.initials: WW
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D010147:Pain Measurement; D019051:Rhizotomy / Q000379:methods*; D013126:Spinal Nerve Roots / Q000601:surgery*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000473:pathology*
keywords: Chronic low back pain; Endoscope; Lumbar zygapophysial joint; Medial branch neurotomy; Rhizotomy