Dr. George Rappard presents results on endoscopic back pain treatment — 4 insights


The director and founder of the Los Angeles Minimally Invasive Spine Institute George Rappard, MD, presented his results on endoscopic back pain treatment at the Annual Symposium of the American Society of Spine Radiology, held from February 13 to 18 in Scottsdale, Ariz.

Here are four insights:


1. The minimally invasive procedure called endoscopic rhizotomy involves the use of a specially designed endoscope placed through a tiny incision in the back. The endoscope is a six-millimeter tube with a high-resolution lens and camera, which the surgeon uses to view high resolution video from inside the spine while operating through a small opening. Patients can return home the same day as the procedure and resume normal activity within days.


2. Dr. Rappard presented on the treatment of back pain caused by the facet joints; facet joint degeneration causes back pain in up to 30 percent of patients, including patients who continue to have pain after other spine procedures. Facet joint-caused back pain has historically been treated with injections that may only last several months, but endoscopic rhizotomy can produce permanent results by visualizing a nerve that senses facet joint pain and cutting it.


3. Dr. Rappard studied patients who suffered from moderate to severe back pain and were at least moderately disabled as a result of their pain despite physical therapy and medications. A screening MRI did not reveal a clear cause of their pain. All patients underwent a test where the suspected facet joint was injected with a numbing agent; if the pain temporarily resolved, the joint was considered to cause the patient's low back pain.


4. In the 38-patient study Dr. Rappard presented on Feb. 16, there were no complications or adverse events and 89 percent of patients achieved meaningful low back pain reduction; 84 percent of patients achieved a meaningful reduction in pain-related disability. Overall, 69 percent of patients experienced at least a 50 percent drop in preoperative pain with consistent results over the long-term. The study expands on a 2013 study demonstrated the procedure was successful but did not collect long-term data.


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