Skip to content
Drew Albert

June 16, 2025

Medial Branch Transection for Facet Arthritis

What is Facet Arthritis?

Facet joint arthritis that causes low-back pain.

Facet arthritis can cause referred pain, in patterns that can cause some confusion as to where the pain is coming from. Here is an example based on the numbering of the facet joints.

Image Source

Osteoarthritis (OA) is a condition that destroys the smooth outer covering (articular cartilage) of bone. As the cartilage wears away, it becomes frayed and rough and the protective space between the bones decreases. During movement, the bones of the joint rub against each other, sending pain signals to nearby nerves and resulting in discomfort or even severe pain.

This bone grinding also commonly leads to bony growths called osteophytes, or bone spurs, forming between joints and/or around the joint area. As these spurs grow outward, they can begin to push against nearby nerves, causing further pain.

The spine acts as the information superhighway for the body, using the nerves that lie within, over, and around it to transport neural sensory signals from your body to your brain, and motor signals from your brain to your body.

The nerves associated with arthritic facet joints send sensory pain signals through this superhighway from the affected joint to the brain.

What is Medial Branch Transection?

A procedure that pinpoints the source of pain and addresses it.

Your surgeon will use an ultra-minimally invasive endoscopic approach to reach and view the medial branch nerve, then transect it. By cutting this sensory nerve, neural receptors can no longer receive the pain signals transmitted from nearby arthritic joints and the nerve cannot grow back to cause pain again. Only the small sensory nerves are cut, which means that the muscle or strength in your back or legs are not affected.

What Are the Benefits?

  • More permanent than radiofrequency ablation 
  • 75% of patients had significantly reduced pain after 5 years11‍

As with all endoscopic spinal surgeries, risks include neurological injury, vascular injury, visceral injury, recurrence, dysesthesia, and incomplete decompression. Additional complications may also occur, including dural tear, hematoma, infection, instability, and facet joint injury.

References:

  1. Zhou T, Salman D, McGregor AH. Recent clinical practice guidelines for the management of low back pain: a global comparison. BMC Musculoskelet Disord. 2024;25(1):344. doi:10.1186/s12891-024-07468-0 
  2. Urits I, Burshtein A, Sharma M, et al. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 2019;23(3):23. doi:10.1007/s11916-019-0757-1
  3. Ruetten S, Komp M, Merk H, Godolias G. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine. 2007;6(6):521-530. doi:10.3171/spi.2007.6.6.2
  4. Lewandrowski KU, Ransom NA, Yeung A. Return to work and recovery time analysis after outpatient endoscopic lumbar transforaminal decompression surgery. J Spine Surg. 2020;6(Suppl 1):S100-S115. doi:10.21037/jss.2019.10.01 
  5. Polikandriotis JA, Hudak EM, Perry MW. Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis. J Orthop. 2013;10(1):13-16. doi:10.1016/j.jor.2013.01.006
  6. Sairyo K, Matsuura T, Higashino K, et al. Percutaneous endoscopic lumbar discectomy for athletes. J Spine. 2013;S5(006):1-4. doi:10.4172/2165-7939.S5-006
  7. Sivakanthan S, Williams JR, Feroze AH, et al. Endoscopic spine surgery in athletes: case series and review of literature. World Neurosurg. 2021;145:702-707. doi:10.1016/j.wneu.2020.08.211 
  8. Gadjradj PS, Broulikova HM, van Dongen JM, et al. Cost-effectiveness of full endoscopic versus open discectomy for sciatica. Br J Sports Med. Published online February 20, 2022. doi:10.1136/bjsports-2021-104808
  9. Page PS, Ammanuel SG, Josiah DT. Evaluation of endoscopic versus open lumbar discectomy: a multi-center retrospective review utilizing the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database. Cureus. 2022;14(5):e25202. doi:10.7759/cureus.25202
  10. Du R, Gao J, Wang B, et al. Percutaneous radiofrequency ablation and endoscopic neurotomy for lumbar facet joint syndrome: are they good enough? Eur Spine J. 2024;33(2):463-473. doi:10.1007/s00586-023-08078-5
  11. Siddiqi F, Romero J, O’Donnel C, Hayes V. Five year long-term results of endoscopic dorsal ramus rhizotomy and anatomic variations of the painful lumbar facet joint. Paper presented at: Society for Minimally Invasive Spine Surgery Annual Conference. November 1-3, 2013; Las Vegas, NV. 
  12. Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008;33(9):931-939. doi:10.1097/BRS.0b013e31816c8af7
Back to Learn