Full-endoscopic rhizotomy for degenerative lumbar facet joint syndrome: a systematic review and meta-analysis

Degenerative changes, such as osteoarthritis, often lead to facet joint syndrome (FJS). Standard treatments include physical therapy, nerve blocks, and radiofrequency rhizotomy. Full-endoscopic lumbar rhizotomy enables direct visualization and precise ablation of the medial branch nerves. Recent studies have shown significant reductions in pain and disability. This study aimed to evaluate the efficacy and safety of full-endoscopic rhizotomy in patients with degenerative lumbar FJS, using pooled data from clinical studies reporting postoperative outcomes.

A systematic literature search was conducted in PubMed and Scopus databases between January 2000 and March 2025, following PRISMA guidelines. Studies reporting preoperative and postoperative outcomes of full-endoscopic rhizotomy in adult patients (18 years of age or older) with lumbar FJS were included. Both randomized controlled trials (RCTs) and observational studies were considered. Risk of bias was assessed using the Cochrane RoB 2 tool for RCTs and Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) for non-randomized studies. Primary outcomes included changes in pain and disability scores measured by the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Meta-analyses were performed using pooled mean differences with 95% confidence intervals (CIs).

Fourteen studies involving a total of 1,467 patients were included. The pooled mean improvement in VAS was -4.36 (95% CI: -4.42 to -4.31), and the mean improvement in ODI was -32.32 (95% CI: -32.84 to -31.80), indicating significant pain and functional improvement after endoscopic rhizotomy. No study reported any severe or permanent complications. Minor complications included transient skin numbness, intraoperative discomfort, and failed sutures. Endoscopic techniques demonstrated lower complication rates (6.67% vs. 30%, P<0.05), although associated with a longer operative time than fluoroscopic-guided percutaneous rhizotomy.

Full-endoscopic rhizotomy is a safe and effective treatment for degenerative lumbar FJS, offering significant and sustained improvements in pain and disability. While it requires a longer operative time than conventional techniques, its satisfactory clinical outcomes and low complication rates support its use as a minimally invasive alternative. Further high-quality comparative studies are recommended to validate long-term benefits.