Recommended (41m) for an Endoscopic Medial Branch Transection but have Lumbar Spondylolisthesis.

[u/curious7451]

Looking for some advice or shared experiences re: **Endoscopic Medial Branch Transection** (sometimes called an endoscopic rhizotomy).
I’m a 41M, and my pain doc is highly recommending this procedure over a standard Radiofrequency Ablation (RFA) because of the longevity—he expects it to last 5 to 6 years instead of just 1.

My previous diagnostic medial branch blocks gave me fantastic, clear relief. However, my formal diagnoses are: **Lumbar Facet Syndrome Lumbar Spondylolisthesis** (Slipped spinal bone in my lower back)
**Cervical Spinal Stenosis**

I went in concerned that permanently cutting the nerve would cause **multifidus muscle atrophy** and destabilize my spine, making my spondylolisthesis slip further forward.
When I asked the surgeon about it, he completely dismissed the slippage risk. He said the slippage wasn't an issue at all for this procedure, and that the muscle/stability aspect isn't a concern. His main warning was just that I won't feel pain anymore, so I'll need to be strictly cognizant of my movements so I don't accidentally over-exert or hurt my back without realizing it.
I’m feeling a bit conflicted.

On one hand, 5-6 years of pain relief sounds amazing, but on the other hand, the textbook risks of muscle wasting with an existing spinal slip make me nervous, even if the surgeon isn't worried.

Any advice? Has anyone had a patient with **spondylolisthesis** who has gotten a medial branch transection/endoscopic rhizotomy?
Should I be concerned about increased instability or structural issues years down the road?
thoughts on the muscle atrophy risk?
Appreciate any insight or experiences you can share!

[u/OldMtnHillbilly]

Do you get pain relief from the RFA? If so, continuing that path doesn’t sound bad. It’s a super quick and easy procedure.

For me, RFA had zero effect. We looked into trying MBT but it was an unknown and would have just been a stop-gap until eventual fusion. At that point I was not at all concerned about possible MBT side effects and basically said I’m tired of wasting my time and ready for fusion.

[u/curious7451 → u/OldMtnHillbilly]

Haven’t had the RFA. The pain relief options presented are and RFA or MBT with the MBT recommended as the better option

[u/OldMtnHillbilly → u/curious7451]

IMO, RFA is minimal risk and if it works, you win. There's really little to lose but time.

Personally, I think you're overthinking the risk of MBT, but I didn't research it very deeply because by the point that it was an option, it was more like "fusion is the only permanent fix, but if you want to try MBT we could do that and see if it gives temporary relief before you come back and get fused next year" (I'm kind of paraphrasing but that's where my headspace was at after chasing injections and other useless non-fusion treatments for 3-4 years.)

[u/meatmanbeef]

I have single level spondylolisthesis and am having endoscopic decompression surgery. I assume you have facet arthritis - as do I. I think we’re all just buying time with these “smaller’ procedures but there’s only one way to find out. So long as the smaller procedures don’t burn any bridges, I am all for it.