Rhizotomy

Overview 

A rhizotomy is a medical procedure used to treat chronic pain or spasticity by selectively damaging certain nerve fibers. These nerves, which transmit signals between the brain and the body, play a crucial role in sensation and movement. By disrupting problematic nerves, the procedure can block pain signals from reaching the brain, providing relief for patients suffering from persistent discomfort.

There are various methods for performing a rhizotomy. Surgeons may cut the nerves directly using either open surgery or a minimally invasive approach, such as an endoscopic procedure that involves a small incision and the use of a camera to precisely locate and sever the nerves. Other techniques include damaging the nerves with chemicals like glycerin or glycerol, or burning them using high-intensity radio waves in a process called radiofrequency ablation.

Since nerves function like electrical cables, carrying important signals for sensations, muscle movement, and bodily functions, damaging them during a rhizotomy disrupts the transmission of pain signals. As a result, patients often experience significant pain relief. However, the procedure must be carefully targeted to avoid unwanted side effects on other nerve functions.

Reasons for undergoing the procedure 

Rhizotomies are procedures used to treat specific causes of chronic pain or spasticity. Different types of rhizotomies target various nerves to address specific conditions. While not typically the first option, healthcare providers may recommend rhizotomies after more conservative treatments, such as physical therapy, NSAIDs, or nerve blocks, have been tried.

Types of rhizotomies 

1. Trigeminal ganglion rhizotomy

This procedure targets nerves in the trigeminal ganglia, which are nerve clusters located on both sides of the face. It is often used to treat: 

• Trigeminal neuralgia. 
• Chronic, treatment-resistant cluster headaches. 
• Atypical facial pain (persistent idiopathic facial pain). 
• Postherpetic neuralgia affecting the face. 
• Cancer-related facial pain. 

Also known as a percutaneous rhizotomy (where “percutaneous” means “through the skin”), this method is effective for facial pain conditions. 

2. Facet rhizotomy

Facet rhizotomy targets the nerve roots passing through the facet joints in the spine. It is typically used to manage chronic pain, particularly in the neck or lower back, stemming from spinal conditions like arthritis or facet joint syndrome.  

• If performed on neck nerves, it is referred to as a cervical rhizotomy. 
• If targeting nerves in the lower back, it is called a lumbar rhizotomy.

3. Selective dorsal rhizotomy

This procedure is primarily used to reduce spasticity in children with cerebral palsy. Spasticity causes muscles to contract involuntarily, disrupting normal movement patterns. Selective dorsal rhizotomy targets specific sensory nerve fibers in the lower spinal cord to alleviate spasticity.  

Not all children with cerebral palsy are candidates for this treatment, so careful evaluation is necessary. 

Risk 

The risks associated with a rhizotomy depend on the specific procedure and the nerves being treated. For instance, loss of facial sensation is a common outcome after a trigeminal rhizotomy. Your healthcare provider will thoroughly discuss all potential risks and complications with you before the procedure.  

Generally, you may experience mild soreness, bruising, or minor bleeding at the site of the rhizotomy injection or incision. These effects are typically minor and resolve within a few days. In rare instances, an infection may develop at the site of the procedure.

Procedure 

Healthcare providers can destroy nerves using various methods, including:  

• Surgical incision: Surgeons can sever nerves either through open surgery, such as in a selective dorsal rhizotomy, or using an endoscopic approach. The endoscopic method involves a small incision and the use of a camera tool to precisely locate and cut the nerves.  
• Chemical ablation: Nerves can be damaged by applying chemicals like glycerin or glycerol.  
• Radiofrequency ablation: This technique uses focused high-intensity radio waves to burn and disable the nerves.

Before the procedure  

The preparation process for a rhizotomy varies depending on the type of procedure, and your healthcare team will guide you through the necessary steps. Don’t hesitate to ask any questions you may have.

Generally, your healthcare team may recommend several tests to ensure the rhizotomy will be effective for you. These tests might include:  

• Imaging tests, such as MRI scans or X-rays.  
• Nerve blocks to identify the problematic nerves.  
• Blood tests.  
• Urinalysis.

In order to make sure the surgery is safe for you; you will speak with an anesthesiologist in advance if general anesthesia is needed. Tests for heart health may be part of this.  

Additionally, you might need to temporarily stop taking certain medications, such as anticoagulants (blood thinners). If this pertains to your circumstances, your healthcare provider will let you know. Always get your healthcare provider’s approval before stopping any medicine.

During the procedure  

The process of a rhizotomy depends on the specific nerves being targeted and the type of rhizotomy being performed—whether it involves surgical cutting, radiofrequency ablation, or chemical ablation.

Rhizotomy may include the following components:  

• Anesthesia or sedation: Most rhizotomies are performed under general anesthesia, which induces sleep and prevents pain during the procedure. In some cases, sedation may be used to help you relax, or a local anesthetic may be applied to numb the area being treated.  
• Imaging assistance: Many rhizotomies require imaging techniques, typically fluoroscopy, to accurately locate the problematic nerves and ensure precise needle placement. This process may involve the use of a contrast dye, which is injected through an IV to enhance the visibility of nerves on imaging scans.  
• Nerve testing: During the procedure, the healthcare provider often tests the affected nerve using electrical stimulation to confirm the correct nerve is being targeted. This may involve inserting a microelectrode through a hollow needle or utilizing electromyography (EMG).  
• Nerve destruction: Depending on the type of rhizotomy, the provider will destroy the targeted nerve using one of several methods: chemical ablation, radiofrequency ablation, or surgical cutting. Chemical and radiofrequency ablations are usually delivered through needles, while surgical cutting may involve either open surgery with a larger incision or endoscopic surgery with a smaller incision.

After the procedure  

Most individuals who undergo a rhizotomy experience substantial, long-lasting pain relief or a marked reduction in spasticity. However, results can vary, and some may experience minimal to no relief. Your healthcare team can offer more detailed information about the expected outcomes for your specific procedure.

Outcome  

Healthcare providers typically consider rhizotomies as a last resort for pain management when other treatments, such as pain medications and physical therapy, have proven ineffective. While a rhizotomy can provide relief for many individuals who opt for the procedure, it may not be suitable for everyone. It’s important to discuss with your provider whether a rhizotomy is the right option for you.

If you notice any signs of complications after the procedure, such as an infection at the incision site or nerve-related symptoms like weakness or burning pain, contact your healthcare provider immediately.