Chronic back pain (CBP) is one of the most common chief complaints among the adult population. Contributing to high healthcare costs, CBP is defined as pain that lasts 12 weeks or longer.1,2 The prevalence of CBP among those between 20 and 69 years of age is 13.1%, with one study showing patients in their fifth decade having the highest likelihood of CBP, at 27.4%.3 Although the prevalence of CBP is high, the ability to accurately diagnose it is relatively low.4,5 Consequentially, conservative treatment for CBP is typically broad, with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids,6 and opioids.7

In cases of conservative therapy-refractory pain, surgical options become the standard of care.4 Traditional measures, such as spinal fusion surgery for the treatment of chronic low back pain, lead to significant morbidity and involve a surgeon treating a symptom without a clearly defined anatomic defect.4 Traditional percutaneous radiofrequency ablation (RFA) is a much less invasive option but does not allow direct visualization of the dorsal medial branch (DMB).8 Moreover, the pain relief provided for these patients is often short-lived, with studies showing a considerable number of patients with pain at 1-year follow up.9,10 For this reason, escalating therapy in the form of multiple percutaneous RFAs is necessary for some patients, such as patients with anatomic variations.10

Endoscopic rhizotomy (ER) is now a viable treatment option for patients with chronic low back pain lacking a radiographically defined anatomic defect.11 Using this technique, surgeons insert an endoscope to view the DMB of the affected zygapophyseal joint and can achieve DMB denervation using RFA. One benefit of this technique is direct visualization of the spinal anatomy, allowing for more precision when severing small branches of the DMB as well as identifying anatomic variants.10 A literature review on this novel surgical technique, including data on patient outcomes, has yet to be provided. The objective of this review was to outline, in a narrative format, the most recent developments of ER for chronic low back pain by providing data on clinical trials, case series, and technical reviews. We also provide an overview of the history of rhizotomy, patient selection, and financial considerations.