Spinal Arthritis: Medial Branch Nerve Transection Animation

Spinal Arthritis: Medial Branch Nerve Transection Animation

This animation 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 of the screen, and their feet are toward the bottom of the screen. First, x-rays are taken during surgery to guide the placement of a needle into the area where the nerve branches near the facet joint. A guidewire is inserted into the needle, and the needle is removed.

Next, a metal instrument is placed over the guidewire to create space for the endoscope. A metal tube, called a cannula, is placed over the instrument. The cannula is held in place with a clamp, and the instrument is removed. The endoscope is passed through the cannula. Here is a view through the camera of the endoscope. Tools are passed through the endoscope to remove soft tissue covering the area where the nerve is located.

Small scissors are used to cut through a ligament that holds the nerve in place. The ends of the ligament are cleared from the camera's view. With the area now more visible, the nerve can be seen clearly. Small scissors are used to cut the nerve. A special tool 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.

This process may be repeated for additional medial branch nerves at other facet joints in the spine. The skin incisions are closed with sutures, and dressings are applied. The procedure is now complete.