Rhizotomy

Rhizotomy is a surgical procedure that intentionally damages or cuts specific nerve roots near the spinal cord. It is performed to relieve severe, long-lasting pain or reduce extreme muscle stiffness (spasticity) when other treatments have not been effective. By interrupting these nerve signals, the procedure aims to improve a person's quality of life.

What is Rhizotomy?

Rhizotomy is a medical procedure that involves intentionally damaging or cutting specific nerve roots near the spinal cord. Its main purpose is to relieve severe, long-lasting pain or reduce extreme muscle stiffness (spasticity) that has not improved with other treatments. By targeting these nerves, the procedure aims to stop unwanted signals from reaching the brain or muscles.

The spinal cord contains many nerve roots that branch out to different parts of the body, carrying signals for sensation, movement, and pain. In a rhizotomy, a surgeon carefully identifies and targets only the nerve roots responsible for the problematic signals. There are different types of rhizotomy. Some are open surgical procedures, requiring an incision, while others are minimally invasive, using a needle inserted through the skin (percutaneous rhizotomy). A common minimally invasive method uses heat, called radiofrequency ablation, to destroy the nerve tissue. Selective dorsal rhizotomy (SDR) is a specific type often performed to reduce severe spasticity, particularly in children with cerebral palsy.

Why it's done

Rhizotomy is performed to alleviate chronic, severe pain or reduce significant muscle stiffness (spasticity) when other less invasive treatments have failed. It is often considered for conditions like severe back pain, cancer-related pain, trigeminal neuralgia (facial pain), or spasticity in children with cerebral palsy. The procedure targets the specific nerves sending problematic signals.

This procedure is typically considered a last resort after other treatments, such as medications, physical therapy, or less invasive injections, have not provided enough relief. For individuals experiencing debilitating chronic pain, rhizotomy can offer a chance for significant improvement in their daily lives. In cases of severe spasticity, especially in conditions like cerebral palsy, the muscles are constantly stiff and tight, making movement difficult and painful. Selective dorsal rhizotomy (SDR) can help reduce this stiffness, potentially improving mobility and comfort. For chronic pain conditions, such as severe back or neck pain, or the intense facial pain of trigeminal neuralgia, rhizotomy aims to interrupt the pain signals before they reach the brain.

How to prepare

Preparing for a rhizotomy typically involves a thorough medical evaluation, including imaging tests and discussions with your healthcare team. You will likely need to stop certain medications, such as blood thinners, before the procedure. Following your doctor's specific instructions for fasting and medication adjustments is crucial for a safe outcome.

Before a rhizotomy, your doctor will conduct a comprehensive assessment. This includes reviewing your medical history, performing a physical examination, and ordering imaging tests like magnetic resonance imaging (MRI) or computed tomography (CT) scans. These tests help pinpoint the exact nerve roots causing your symptoms. You will receive specific instructions about medications. It is common to be asked to stop taking blood-thinning medications, such as aspirin or ibuprofen, several days or a week before the procedure to reduce the risk of bleeding. You will also be told not to eat or drink anything for several hours before the procedure, usually after midnight the night before. It is important to arrange for someone to drive you home after the procedure, as you will not be able to drive yourself.

What happens during

During a rhizotomy, you will receive anesthesia to ensure comfort. The surgeon will locate the specific nerve roots to be treated, often using imaging guidance. Depending on the type, a small incision may be made, or a needle inserted through the skin. The targeted nerve roots are then cut or destroyed using heat (radiofrequency), chemicals, or other methods.

The type of anesthesia used can vary; it might be local anesthesia with sedation, where you are awake but relaxed, or general anesthesia, where you are completely asleep. Once the anesthesia takes effect, the medical team will position you to allow access to the treatment area. For percutaneous rhizotomy, the doctor uses X-ray or other imaging guidance to insert a thin needle through your skin to the targeted nerve root. A small electrical current may be used to confirm the needle's position and ensure it is at the correct nerve. Then, heat (radiofrequency energy), a chemical, or another method is used to damage the nerve. For an open surgical rhizotomy, a small incision is made, and the surgeon directly accesses and cuts the problematic nerve roots. The procedure's duration varies but typically ranges from one to several hours.

Recovery & timeline

Recovery after a rhizotomy varies depending on the type of procedure and individual factors. You may experience some pain or discomfort at the incision site, which can be managed with medication. Most people can return home within a day or two, but full recovery and return to normal activities may take several weeks. Physical therapy is often recommended, especially for spasticity.

Immediately after the procedure, you will be monitored in a recovery area as the anesthesia wears off. You may feel some soreness, numbness, or weakness in the treated area. Pain medication will be provided to manage any discomfort. The length of your hospital stay can range from a few hours for a percutaneous procedure to a few days for an open surgical rhizotomy. Your doctor will give you specific instructions for wound care and activity restrictions. You might need to avoid strenuous activities, heavy lifting, or certain movements for several weeks. For individuals who undergo selective dorsal rhizotomy (SDR) for spasticity, an intensive physical therapy program is crucial. This therapy helps strengthen muscles, improve balance, and retrain the body for new movement patterns. The full benefits of the procedure, especially for spasticity, may become more apparent over several months as you progress through rehabilitation.

Risks & side effects

Like any surgical procedure, rhizotomy carries potential risks and side effects, although serious complications are rare. These can include infection, bleeding, nerve damage leading to weakness or numbness, and temporary or permanent changes in sensation. There's also a chance the pain or spasticity may not be fully relieved or could return over time.

General risks associated with any surgery include infection at the incision site, bleeding, and adverse reactions to anesthesia. Specific risks related to rhizotomy involve potential damage to surrounding nerves. This nerve damage could lead to new areas of numbness, weakness, or altered sensation. In rare cases, more severe complications like loss of bladder or bowel control can occur, especially if nerves controlling these functions are affected. There is also a possibility that the procedure may not completely alleviate the pain or spasticity, or that symptoms could return over time if the nerves regenerate or new pain pathways develop. Your clinician will discuss all potential risks and benefits with you in detail, helping you understand what to expect and make an informed decision.

Success rate

The success rate of rhizotomy varies significantly depending on the condition being treated, the specific type of procedure, and individual patient factors. For conditions like severe spasticity in children with cerebral palsy, selective dorsal rhizotomy (SDR) often shows good long-term results in reducing stiffness. For chronic pain, success can range, with some people experiencing significant relief while others may have less benefit or a return of symptoms over time.

For selective dorsal rhizotomy (SDR) performed to treat severe spasticity, particularly in children with cerebral palsy, studies often report positive outcomes. Many individuals experience a significant and lasting reduction in muscle stiffness, which can lead to improved walking ability, easier care, and better overall quality of life. The benefits of SDR are often sustained over many years. For chronic pain conditions, the effectiveness of rhizotomy can be more variable. While many people experience substantial pain relief, the duration of this relief can differ. For some, the effects may last for several months to years, while for others, pain may gradually return. This can happen if the treated nerves regenerate or if other pain pathways become more active. Your healthcare provider will discuss the expected success rate for your specific condition and the type of rhizotomy being considered, based on current medical evidence.

Frequently asked questions

Is rhizotomy a permanent solution for pain?

Rhizotomy aims for long-term relief, but it may not always be permanent. Nerves can sometimes regenerate, or new pain pathways might develop over time, causing symptoms to return. The duration of relief varies greatly depending on the individual and the specific condition being treated.

What is the difference between rhizotomy and neurectomy?

Rhizotomy specifically targets nerve roots near the spinal cord, while a neurectomy involves cutting or removing a peripheral nerve anywhere in the body. Both procedures aim to relieve pain by interrupting nerve signals, but they target different parts of the nervous system.

Can rhizotomy cause paralysis?

While rare, there is a risk of nerve damage during a rhizotomy that could potentially lead to weakness or, in very severe cases, paralysis. Surgeons take great care to identify and protect motor nerves, and the procedure is usually performed by highly skilled specialists to minimize this risk.

How long does the pain relief from rhizotomy last?

The duration of pain relief from a rhizotomy varies widely. For some, relief can last for several months to years, while for others, symptoms may return sooner. Factors like the underlying condition, the specific nerves treated, and individual healing play a role in how long the effects last.

Is rhizotomy only for back pain?

No, rhizotomy is not only for back pain. While it can be used for severe chronic back pain, it also treats other conditions. These include severe muscle stiffness (spasticity), facial pain (trigeminal neuralgia), and pain related to cancer in various parts of the body.

Will I need physical therapy after a rhizotomy?

Physical therapy is often recommended after a rhizotomy, especially for procedures done to reduce muscle stiffness (spasticity). It helps you regain strength, improve mobility, and learn new ways to move your body effectively. Your doctor will advise if physical therapy is right for your recovery.

Sources

• MedlinePlus — Rhizotomy
• Mayo Clinic — Rhizotomy
• Cochrane Library — Rhizotomy