Spinal Arthritis: Medial Branch Nerve Transection

Spinal Arthritis: Medial Branch Nerve Transection

This surgical video demonstrates a medial branch nerve transection using an endoscope. Within the spine, the facet joints connect the vertebrae and allow for the spine to move. Over time, the cartilage that lines these joints can wear down, and arthritis can result. The medial branch nerve is a sensory nerve that connects to the facet joints. When arthritis occurs, these nerves send out pain signals. To reduce pain, these nerves can be cut, or transected, to stop the pain signals from reaching the brain. Because these nerves do not connect to the muscles, cutting them will not affect the spine's movement or function.

This procedure can be performed endoscopically with a small incision where surgical instruments are inserted through a small tube, called an endoscope, that contains a light, a camera, and a channel for tools to pass through. Here we see a patient lying face down on the operating table. Their head is toward the top left corner of the screen, and their feet are toward the bottom right corner of the screen. First, the surgeon uses x-rays to help guide the placement of the incision. The surgeon places a metal instrument into the incision to create and confirm the path for the endoscope.

The surgeon places a metal tube, called a cannula, over the metal instrument and removes the instrument. Next, the surgeon passes the endoscope through the cannula. Here is a view through the camera of the endoscope. The surgeon uses small instruments to remove soft tissue that covers the area where the nerve is located. Once the surgeon has removed enough, the nerve is identified.

Next, the surgeon uses small scissors to cut the medial branch nerve. The surgeon uses a special tool that uses electrical current to gently heat the ends of the nerve and the surrounding bone, clearing away the rest of the nerve and decreasing bleeding to minimize pain. The surgeon may repeat this process for additional medial branch nerves at other facet joints in the spine.

The surgeon will close the skin incisions with sutures, and the procedure is complete.