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Beyond Facets, Beyond Dogma: Endoscopically Directly Visualized Medial Branch Transection for the Axial-Radicular
Kai-Uwe Lewandrowski1,2,3,4, John Elfar3, Stefan Hellinger5
1Department of Orthopedics at Hospital Universitário Gaffree Guinle Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil business@tucsonspine.com.
International Journal of Spine Surgery
|July 31, 2026
Summary
Endoscopic posterior sensory network interruption is distinct from radiofrequency ablation. This technique offers a motion-preserving option for axial-radiating pain when functional diagnostics confirm dorsal root ganglion involvement.
Area of Science:
- Spinal Surgery
- Pain Management
- Neuroscience
Background:
- Axial and radiating pain often coexist, influenced by dorsal root ganglion (DRG) excitability.
- Imaging-symptom noncorrelation is common in spinal pain presentations.
- Current treatment paradigms may not adequately address DRG-dominant pain.
Purpose of the Study:
- Define endoscopic posterior sensory network interruption as distinct from radiofrequency ablation.
- Propose a physiology-informed pathway for its application.
- Position this endoscopic technique after functional confirmation and before structural reconstruction.
Main Methods:
- Narrative, mechanism-informed review of evidence.
- Synthesis of data on DRG neurobiology, diagnostics, and endoscopic procedures.
- Development of a decision framework with diagnostic anchors and safety boundaries.
Main Results:
- Endoscopic neurectomy is indicated for physiologically localized pain with functional confirmation.
- Magnetic resonance imaging noncorrelation is a classification, not a contraindication.
- The framework includes safety boundaries for procedural "dose" and reassessment, especially in vulnerable phenotypes.
Conclusions:
- Directly visualized endoscopic interruption is a distinct surgical procedure from radiofrequency lesioning.
- It offers a motion-preserving, escalation-friendly option for selected DRG-dominant pain.
- This endoscopic framework addresses treatment gaps in noncorrelative imaging presentations.
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