Endoscopic Medial Branch Nerve Rhizotomy vs. Traditional Percutaneous Radiofrequency Ablation: Advancing Pain Relief for Chronic Back Pain

By John K. Hong, M.D. | 2/16/2025

Endoscopic Medial Branch Nerve Rhizotomy

Chronic low back pain remains one of the most challenging conditions for both patients and physicians. Among the most effective interventional techniques for facet-mediated back pain are medial branch nerve ablation procedures. Traditionally, percutaneous radiofrequency ablation (RFA) has been the gold standard for targeting these pain-generating nerves. However, recent advances in endoscopic spine interventions have introduced endoscopic medial branch nerve rhizotomy (EMBR) as a promising alternative with distinct advantages.

This blog explores the key differences between these techniques, emphasizing why the endoscopic approach may represent the future of facet joint pain treatment.

Traditional Percutaneous Radiofrequency Ablation (RFA)

Percutaneous RFA is a minimally invasive procedure that involves placing a radiofrequency probe near the medial branch nerves under fluoroscopic guidance. The probe delivers thermal energy, causing neurotomy and subsequent pain relief. This technique has been a mainstay in the management of chronic facet joint pain for decades.

Pros of Percutaneous RFA

• Minimally invasive – Requires only a small needle and fluoroscopic guidance.

• Proven efficacy – Supported by decades of research in treating facet-mediated pain.

• Outpatient procedure – Performed quickly under local anesthesia with minimal downtime.

Limitations of Percutaneous RFA

• Nerve regeneration and pain recurrence – Since RFA does not fully remove the nerve, pain often returns within 6 to 12 months as the nerve regenerates.

• Limited visualization – Fluoroscopy provides only bony landmarks, lacking direct visualization of the medial branch nerve.

• Inconsistent lesioning – Variability in electrode positioning may lead to suboptimal results.

  
  

Endoscopic Medial Branch Nerve Rhizotomy (EMBR): A Game-Changer in Spine Interventions

Endoscopic medial branch nerve rhizotomy takes the treatment one step further by directly visualizing and ablating the nerve using an endoscope. This technique involves a small incision through which a working cannula is inserted, allowing the surgeon to use a high-definition camera to identify and sever the medial branch nerve more precisely.

Advantages of Endoscopic Medial Branch Nerve Rhizotomy

1. Direct Visualization = Improved Precision

   • Unlike percutaneous RFA, which relies on indirect landmark guidance, EMBR enables direct visualization of the medial branch nerve. This leads to more accurate nerve identification and ablation for better outcomes.

2. More Complete and Longer-Lasting Pain Relief

   • Endoscopic rhizotomy allows for mechanical severing and cauterization of the nerve, which is more effective than RFA’s thermal lesioning alone.

   • Studies suggest this results in longer pain relief compared to traditional percutaneous RFA, often extending beyond 12 to 24 months.

3. Reduced Risk of Nerve Regeneration

   • Since EMBR completely transects the nerve, the likelihood of nerve regrowth is significantly reduced compared to the thermal lesions of RFA, which leave a chance for re-innervation.

4. Addresses Additional Pain Generators

   • The endoscopic approach allows for direct debridement of inflamed tissue, removal of impinging osteophytes, and better control over pain-generating structures beyond the medial branch nerve itself.

5. Minimally Invasive with Rapid Recovery

   • Similar to percutaneous RFA, EMBR is an outpatient procedure with small incisions and minimal tissue disruption. Patients typically recover within days rather than weeks.

6. Potential for Greater Long-Term Cost-Effectiveness

   • While EMBR may have a higher initial cost than RFA, its longer-lasting relief may reduce the need for repeated procedures, making it more cost-effective in the long run.

     
     

Who Is a Candidate for Endoscopic Medial Branch Nerve Rhizotomy?

Patients with chronic facet joint pain that has responded positively to medial branch blocks are ideal candidates for EMBR. This includes individuals who:

✅ Have persistent axial back pain unresponsive to conservative treatments.

✅ Have experienced temporary pain relief from diagnostic medial branch blocks.

✅ Seek longer-lasting pain relief compared to traditional RFA.

✅ Wish to minimize recurrence and avoid more invasive spine surgery.

Conclusion: Is Endoscopic Rhizotomy the Future of Facet Pain Treatment?

Both percutaneous RFA and endoscopic medial branch nerve rhizotomy are effective interventions for facet-mediated back pain, but the endoscopic technique offers significant advantages in precision, longevity of pain relief, and the ability to directly visualize and address pain generators.

As technology advances and endoscopic techniques become more widely adopted, EMBR is poised to redefine how we treat facet joint pain, offering patients a more durable, effective, and minimally invasive option for long-term relief.

If you or someone you know is struggling with chronic back pain and looking for an advanced, long-lasting treatment alternative to traditional RFA, consider consulting with a specialist experienced in endoscopic spine interventions.

Dr. John Hong is one of the few providers in Utah providers able to offer this newer, effective treatment for chronic back pain from painful, arthritic spinal joints.

Want to learn more? Contact our office at (435) 714-7180 to discuss whether endoscopic medial branch nerve rhizotomy is right for you! Parkview has offices in Park City and Salt Lake City.

Understanding Intracept: A Breakthrough in Chronic Vertebrogenic Back Pain Treatment

By John K. Hong, M.D. | 1/29/2025

Chronic lower back pain can be debilitating, affecting millions of people worldwide. Traditional treatments, such as physical therapy, medication, and surgery, don’t always provide lasting relief. However, a new and innovative approach—Intracept—is offering hope for those suffering from vertebrogenic lower back pain.

What Is Intracept?

Intracept is a minimally invasive procedure designed to alleviate chronic lower back pain by targeting the basivertebral nerve (BVN). This nerve transmits pain signals from the vertebral endplates, which can become irritated due to degenerative changes. The Intracept procedure works by using radiofrequency energy to ablate the BVN, effectively disrupting pain transmission and providing long-term relief.

How Does the Intracept Procedure Work?

The Intracept procedure involves a few key steps:

1. Patient Selection – Not all back pain sufferers are candidates for Intracept. The procedure is specifically designed for individuals diagnosed with vertebrogenic pain, confirmed via MRI.

2. Minimally Invasive Approach – The procedure is performed under fluoroscopic guidance, requiring only a small incision.

3. Radiofrequency Ablation – A specialized probe delivers controlled radiofrequency energy to heat and disable the basivertebral nerve.

4. Recovery and Relief – Because it is minimally invasive, patients typically experience a short recovery time and significant pain reduction within weeks.

   
   

Benefits of Intracept

• Long-Term Pain Relief – Clinical studies have shown that patients experience sustained pain relief for at least five years post-procedure.

• Minimally Invasive – Unlike spinal fusion or other surgical interventions, Intracept requires no implants or structural modifications to the spine.

• Quick Recovery – Most patients return to daily activities within a few days to weeks.

• Opioid-Free Pain Management – By addressing the root cause of pain, Intracept reduces dependency on pain medications.

  
  

Who Can Benefit from Intracept?

The best candidates for Intracept are individuals who:

• Have chronic lower back pain lasting six months or more.

• Have MRI-confirmed Modic Type 1 or 2 endplate changes, indicative of vertebrogenic pain.

• Have not found relief with conservative treatments like physical therapy or injections.

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Final Thoughts

Intracept represents a promising advancement in pain management for those suffering from vertebrogenic lower back pain. As research continues to validate its effectiveness, more patients may find relief through this innovative procedure. If you or someone you know is struggling with chronic lower back pain, contact our team at Parkview Pain and Regenerative Institute.

For more information, visit the Boston Scientific Intracept site.

Regenerative Medicine Trends: Unlocking the Potential of Plasma Protein Concentrate: What It Is and How It Works

By John K. Hong, M.D. | 12/28/2024

Plasma Protein Concentrate (PPC) therapy is a groundbreaking advancement in regenerative medicine. This natural treatment harnesses the healing power of proteins found in your blood plasma to promote tissue repair, reduce inflammation, and support overall cellular health. Whether you’re dealing with joint pain, a chronic injury, or looking to rejuvenate your skin, PPC offers a safe and innovative solution.

What Is Plasma Protein Concentrate?

Plasma is the liquid component of your blood, comprising water, electrolytes, and proteins essential for various bodily functions. While most people are familiar with Platelet-Rich Plasma (PRP), PPC is different—it focuses on isolating and concentrating plasma proteins like alpha-2macroglobulin (A2M), IL-1 receptor antagonist, and PDGF-BB. These proteins play key roles in wound healing, inflammation control, and tissue regeneration.

Scientific evidence points to A2M (Alpha-2-Macroglobulin) as the key to slowing the progression of osteoarthritis at the molecular level. A2M is a broad spectrum multi-purpose protease inhibitor (powerful chemical in destroying proteins that cause arthritis) that captures and inactivates the three major chemicals that lead to joint breakdown and cartilage damage. Once these bad chemicals are trapped by A2M, the body can then quickly eliminate them. It is also reported that A2M can act as a powerful anti-inflammatory and aid in pain management.

Research on IL-1ra (Interleukin-1 Receptor Antagonist Protein) has shown that it specifically prevents IL-1ra from binding to its receptors, slowing the progression of osteoarthritis in joints.  

By using your own blood, PPC therapy is a natural, autologous treatment, minimizing the risk of allergic reactions or complications. It’s increasingly used in both medical and cosmetic fields, providing a versatile approach to healing and rejuvenation.

How Does Plasma Protein Concentrate Work?

The magic of PPC lies in its ability to leverage the body’s innate healing mechanisms.

Here’s how it works:

1. Extraction: A small amount of your blood is drawn, usually from your arm.

2. Processing: The blood is placed in a centrifuge to separate the plasma from other components like red blood cells and platelets.

3. Concentration: Plasma proteins are isolated and concentrated using an advanced microfilter to extract water from the plasma.

4. Application: The PPC is injected into the treatment area (e.g., joints, tendons, or skin) or applied topically, depending on the condition being addressed.

   
   

Once administered, the concentrated proteins get to work by enhancing cellular communication, reducing inflammation, and stimulating tissue repair. In aesthetic applications, PPC can improve skin hydration, elasticity, and overall appearance.

Why Choose PPC for Regenerative Therapy?

• Natural and Safe: Because PPC is derived from your own blood, it carries minimal risk of adverse reactions.

• Versatile: It can treat a wide range of conditions, from joint pain to skin rejuvenation.

• Minimally Invasive: The procedure is quick, typically taking less than an hour, and requires little to no downtime.

  
  

Plasma Protein Concentrate therapy represents a new frontier in personalized medicine. Whether you’re looking to enhance your recovery from an injury or achieve a youthful glow, PPC offers a scientifically backed, natural solution that works in harmony with your body.

Are you ready to explore the benefits of PPC? Consult with Parkview Pain & Regenerative Institute with offices in Park City and Salt Lake City, Utah to see if this innovative treatment is right for you.

Parkview uses the highest quality products from Apex Biologix, based out of Salt Lake City, Utah.