What is DVR?

Direct Visual Rhizotomy (DVR) is an endoscopic, ultra-minimally invasive procedure for the treatment of low back pain caused by arthritic or injured joints in the low back. The goal of direct visual rhizotomy is to silence your back pain by cutting the nerve root branches which transmit the pain signal. The idea is similar to a root canal. Like some nerves in the mouth, the single nerve that goes to each of your facet joints in the spine only exists for one reason: to transmit pain signals. While the joint itself is so tiny it cannot be repaired, we can sever the nerve, so you don’t have to feel the associated pain.

Who is a Candidate?

DVR is a very effective treatment for patients who are suffering with facet join pain. Often called arthritis of the spine, facet joint pain is mostly in your back, radiates to your buttocks, feels like it’s in your hips, and burns on the outer sides of your thighs. DVR is also extremely effective for patients who have had Radio Frequency Ablation (RFA) but whose pain eventually returned. DVR also works well to treat back pain that developed after laminectomy or microdiscectomy surgery, and is also a very good alternative to adjacent level fusion surgery.

In order to be a candidate for direct visual rhizotomy you must have 1) pain that is typical of a joint in the low back; 2) MRI findings showing swelling of the affected joints; 3) clinical examination by a physician confirming the MRI findings are your typical pain; and 4) a medial branch block for confirmation.

Our Process

At Phoenix Spine & Joint, our doctors look for three indicators to identify candidates for DVR.

  1. Our doctors review your MRI to confirm your back pain is coming from a swollen facet joint.
  2. Our doctor’s confirm this is the source of your pain during your physical examination by palpitating (pushing down on) that precise area.
  3. Our doctors then numb the nerve branches that serve the joint. If this is the source of your pain, the numbing should relieve the pain for a few hours.

If the medial branch block produces several hours of complete relief, followed by the return of your usual pain, then we know you are an excellent candidate for DVR.

DVR is an ultra-minimally invasive procedure. Our doctor’s insert a small surgical cannula, about the width of a straw, into your back. They then insert a small endoscope, just 3.5 mm in width, to be able to have a “direct visual” of the affected nerve. They then sever the nerve, remove the cannula, and close the very small incision with bonding glue. The DVR procedure usually takes around 30 min., and is done under twilight sedation, or general anesthesia.


Nearly all patients walk out of our facility under their own power an hour after the surgery is complete. We recently had a patient dance in recovery room because, for the first time in a long-time, they were finally pain free! Many patients are even able to return to work the next day, if needed.

Patient Education Video

Additional Resources

International Journal of Medical Sciences Research on the use of DVR

Society for Minimally invasive Spine Surgery Study on the Long-Term Effects of Rhizotomy

A Study on DVR by International Journal of Spine Surgery

Learn about how we use a Medial Branch Block to diagnose not treat back pain