RHIZOTOMY

What is a Rhizotomy?

The medical term ‘Rhizotomy’ refers to a minimally invasive surgical procedure to remove nerve roots in the spinal cord. This procedure helps to remove sensation from a painful nerve by killing nerve fibers responsible for sending pain signals to the brain. Sensory nerves responsible for sensations of touch, pressure, and vibration can also carry unpleasant sensations to the brain. The brain interprets these unpleasant sensations as pain. Intentional severance or impairment to these nerves blocks signals to the brain, thereby resulting in pain relief. The problematic spinal nerve roots may either be severed with the help of a surgical instrument or burned with a chemical or electric current. Rhizotomy mostly occurs to relieve severe chronic back pain and to remove symptoms associated with neuromuscular conditions like cervical dystonia, spastic diplegia, and other forms of spastic cerebral palsy.

What are the Conditions for a Rhizotomy?  

Rhizotomy may occur to relieve different types of pain and symptoms of abnormal nerve activity such as:

  • Trigeminal neuralgia: intense pain caused by compression of the trigeminal nerve in the face
  • Spasticity: an abnormal muscle tightness usually caused by damage to nerve pathways within the spinal cord or brain. Spasticity occurs mostly among individuals with neurological conditions such as Cerebral palsy and Multiple sclerosis.
  • Pain in the back and neck resulting from arthritis, herniated discs, and other degenerative spine conditions
  • Spinal pain due to cancers of the back
  • Spinal osteoarthritis (Spondylosis)

What are the Types of Rhizotomy?

There are two common types of Rhizotomy procedures; Radiofrequency rhizotomy and Endoscopic rhizotomy. The aim of both procedures involves destroying the fibers within a nerve that carry pain signals.

Radiofrequency Rhizotomy

Radiofrequency Rhizotomy, also known as radiofrequency ablation, involves the use of a needle to transfer a radiofrequency current that heats the targeted nerves. In this procedure, the spinal specialist uses a fluoroscopic X-ray to determine the exact location of the nerve.

Endoscopic Rhizotomy

Endoscopic Rhizotomy involves the use of a small camera device called an endoscope to locate the affected nerves. The surgeon makes a small incision to allow the endoscope to pass and directly travel through the nerve branch to identify the problem nerves and then perform the procedure under direct visualization. This procedure allows the surgeon to locate the nerves without interfering with other healthy organs and tissues.

What are the Complications of Rhizotomy?

A Rhizotomy procedure may occur under general or local anesthesia depending on the location of the affected nerves. The procedure itself takes only a few minutes after which the patient will require several hours of rest in the recovery room. 

Common side effects of rhizotomy include pain, numbness, and swelling at the surgical site. Other complications include bleeding, infection, nausea, vomiting, sensory change (feeling of numbness), and anesthesia complications.

Like most surgical procedures, rhizotomy does not offer a 100% success rate for all patients that undergo the surgery. Some patients may notice short-term pain relief, while others may feel no significant pain relief after the surgery. Some patients may experience the pain gradually returning after a while even after a successful surgery. 

References 

“Rhizotomy”. Oxford Dictionaries UK English Dictionary. Oxford University Press. n.d. Retrieved 2016-01-21.

“Selective Dorsal Rhizotomy (SDR) Surgery for Cerebral Palsy | St. Louis Children’s Hospital”. www.stlouischildrens.org. Retrieved 2017-11-12.

Mukherjee, Angshuman; Chakravarty, Ambar (2010-12-17). “Spasticity Mechanisms – for the Clinician”. Frontiers in Neurology. 1: 149

Bales, James; Apkon, Susan; Osorio, Marisa; Kinney, Gregory; Robison, R. Aaron; Hooper, Erin; Browd, Samuel (2016). “Infra-Conus Single-Level Laminectomy for Selective Dorsal Rhizotomy: Technical Advance”. Pediatric Neurosurgery. 51 (6): 284–291

McLaughlin, J; Bjornson, K; Astley, S; Graubert, C; Hays, R; Roberts, Theodore; Price, Robert; Temkin, Nancy (1998). “Selective dorsal rhizotomy: Efficacy and safety in an investigator-masked randomized clinical trial”. Developmental Medicine and Child Neurology. 40 (4): 220–232