Endoscopic thoracic facet joint denervation: A technical description and two cases

Background Recent dissection literature describes a common articular branch originating directly from the primary dorsal ramus or the proximal portion of the medial branch of the primary dorsal ramus of the spinal nerve, suggesting the possibility of new strategies for thoracic facet joint (TFJ) denervation. An endoscopic approach provides the ability to directly visualize and rapidly denude the entire inferior-lateral to superior-lateral aspect of the TFJ capsule while avoiding the exiting spinal nerve, ensuring complete transection of any articular branch from the primary dorsal ramus external to the neural foramen as well as any inconsistent articular branches from the medial branches prior to their termination in the TFJ capsule. Objective Describe a novel technique for endoscopic TFJ denervation (ETFJD) and two case reports. Methods Two patients who underwent ETFJD with our inferior-lateral to superior-lateral TFJ capsule-targeting technique were contacted. Numerical Rating Scale (NRS) pain intensity, Patient Global Impression of Change (PGIC), and patient satisfaction scores were collected by standardized telephone survey. Results At 13.7 months, Patient 1 reported asymmetric improvement (left-sided NRS reduction from 9 to 2; right-sided NRS improvement from 9 to 7); PGIC 7, and satisfaction 5. Patient 2 reported NRS reduction from 9 to 0 at 17.9 months; PGIC 7, and satisfaction 5. No procedural complications occurred. Conclusion We describe a novel technique for ETFJD and two case reports. Formal evaluation and optimization of this treatment strategy for refractory thoracic facet joint pain is warranted.