Dr. George Rappard Presents Results on Endoscopic Back Pain Treatment at the American Society of Spine Radiology 2018 Annual Symposium

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Endoscopic lumbar rhizotomy is a safe and minimally invasive surgical treatment for certain patients with moderate to severe back pain. Patients exhibited improvement in pain and disability that were long lasting.

Los Angeles Minimally Invasive Spine Institute Neurointerventional Surgeon Dr. George Rappard presented his results on the endoscopic treatment of back pain at the Annual Symposium of the American Society of Spine Radiology, held from February 13-18 in Scottsdale, Arizona. The minimally invasive procedure, endoscopic rhizotomy, involves the use of a specially designed endoscope that is placed through a tiny incision in the back. The endoscope is a tiny 6-millimeter tube with a high-resolution lens and camera. Through the endoscope the surgeon can view high resolution video from inside the spine while operating through a small opening. Patients return home the same day and can resume normal activity, such as work and exercise, within days.

Dr. Rappard's results concern the treatment of back pain caused by the facet joints, important joints in the back of the vertebra that join each vertebra together. Over time the facet joints become degenerated and are a cause of back pain in up to 30% of patients, including patients who continue to have pain after other spine surgery procedures. In other cases, injuries such as a fall or an automobile accident can cause damage to the facet joints, resulting in unrelenting pain.

Historically, persistent back pain emanating from the facet joints has been treated with injections that may only last several months. Some patients undergo a procedure, called a radiofrequency rhizotomy, where the pain sensing nerves of the facet joints are treated by causing a precise burn of the nerves using an energy producing electrode. However, the nerves will regenerate, and symptoms return in 3 to 6 months. Endoscopic rhizotomy provides doctors with a minimally invasive treatment option that can produce permanent results. The use of the endoscope allows the surgeon to directly visualize the injured or painful joint. A microscopic nerve that senses pain from the joint is also visualized. The nerve is then cut, allowing complete and normal function of the back, without any longer feeling the back pain that was there before.

There were several pre-requisites to being considered for the endoscopic rhizotomy procedure that Rappard studied; Patients had to suffer from at least moderate to severe back pain and had at least moderate disability due to their pain. All patients had symptoms despite physical therapy and medications. A screening MRI did not reveal an obvious cause of pain. Lastly, all patients underwent a test where the suspected offending facet joint was injected with a numbing medication. If the pain temporarily resolved, the joint was considered to be the cause of the patient's low back pain.

There were no complications or adverse events in the 38-patient study presented February 16. A meaningful reduction in low back pain was reached in 89% of patients and a meaningful reduction in pain related disability was reached in 84% of patients. Average low back pain scores dropped from 75 to 28. Average percentage of disability dropped from 63 to 30. Overall, 69% of patients experienced at least a 50% drop in their pre-operative pain. Results were consistent over the long term. 68% of patients had greater than 3 month, 53% of patients had greater than 6 month and 21% of patients had greater than 1 year follow up. All patients returned home the day of surgery. All patients were free to resume previous activities after a 4-day clinic visit. The current study expands on a 2013 study that showed the procedure was successful but lacked long term data.

The Los Angeles Minimally Invasive Spine Institute was established by Dr. Rappard in 2012. The institute has its main office in the Miracle Mile region of Los Angeles. Dr. Rappard or Institute staff can be contacted at info@lamisinstitute.com, through the institute at 323-857-5300, or on the web at http://www.laspinecare.com

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Evelyn Gonzalez
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