Back pains are so prevalent that eight out of ten people experience them at a given point in their lives. However, if the pain persists for twelve or more weeks, it ceases to be acute and becomes chronic. At this point, you must seek relief. Back pains do not just inhibit your physical capabilities. Pain that continues for several weeks, months, or even years could also affect your emotions and lead to depression.
Dr. George Rappard’s Clinic in Los Angeles is devoted to discovering the most advanced, effective, and minimally invasive therapeutic procedures available for back pains. You can get in touch with our team of spine specialists for treatment. After an evaluation, we might recommend a procedure known as rhizotomy to alleviate the pain based on the reason for your back pains.
Rhizotomy is a surgical procedure to sever the nerve roots that convey pain signals to the brain. The surgeon cuts the nerves at the point where they enter the spine. When the doctor disconnects the nerves, the pain signals will not reach the brain; thus, you will not feel the pain. Rhizotomy, also referred to as neurotomy or radiofrequency ablation, relieves chronic back pains and provides a nine-month relief. In particular cases, you will be relieved from back pains for up to three or more years until the nerves recover and can start transmitting pain again. If necessary, you can have rhizotomy repeated.
Rhizotomy surgical procedure is minimally invasive; thus, it is often an outpatient service. The doctor uses an electrical or chemical current to burn the nerves causing pain or cuts them using surgical equipment. A patient who undergoes rhizotomy receives pain relief almost immediately. Therefore, there is a significant reduction in the requirement for pain medications. There is no or little recovery period.
Your physician may recommend rhizotomy if you are experiencing chronic back pains, particularly in the cervical spine (neck) or lumbar spine (lower back), after other traditional treatment options have failed. Rhizotomy comes with benefits that other treatments do not have:
- With this procedure, the surgeon will see the nerve roots causing the pain and target only them
- Most patients who have undergone rhizotomy achieve more long-lasting pain relief than they do with other treatment options.
The rhizotomy procedure is not an opinion for pregnant patients, patients with a bleeding disorder, or those with an infection.
Types of Rhizotomy
Rhizotomy procedure comes in different forms. All these types entail destroying the nerve roots that convey pain signals. Based on where the nerve is located, rhizotomy procedures may be conducted under local or general anesthesia and usually use fluoroscopy, x-ray, or other image-guided techniques to ensure accuracy.
Glycerol/glycerin rhizotomy— this form of rhizotomy involves a surgeon delivering a small quantity of chemical (glycerol or glycerin) to the root of the affected nerve using a needle. The chemical eats up the nerve-based pain fibers within forty-five to sixty minutes.
Endoscopic rhizotomy— this kind of rhizotomy involves a surgeon locating the affected nerves using an endoscope and severing its fibers. The surgeon inserts the endoscope through a tiny cut via a tubular retractor system (a series of tubes). This enables them to reach the nerve while avoiding healthy tissues and organs. Endoscopic rhizotomy is also known as a direct visualized rhizotomy.
Radiofrequency ablation— radiofrequency ablation is also called radiofrequency rhizotomy. It resembles glycerol rhizotomy. However, instead of destroying the nerve-based pain fibers with a chemical, the doctor uses a radiofrequency current to burn them. It is usually used in patients who fail to achieve complete relief after undergoing glycerol rhizotomy or those experiencing recurrent pain and might need help to break up scar tissue.
What Procedure Works Better?
These rhizotomies have the same objective but achieve it in different ways. However, endoscopic rhizotomy and radiofrequency ablation are the most commonly recommended types of rhizotomy. The endoscopic rhizotomy procedure is mainly recommended when radiofrequency ablation fails since it is more effective in alleviating pain. Consider these critical differences:
- Radiofrequency ablation relieves pain for a maximum of a year. However, the endoscopic rhizotomy benefits can last for three to five years.
- Most patients experience pain relief right after undergoing endoscopic rhizotomy. On the other hand, it may take one month to experience the radiofrequency ablation effects.
- A surgeon conducting the endoscopic rhizotomy procedure can directly see the nerves rather than depending on an x-ray.
Why It Is Done
Your doctor may recommend rhizotomy if you need to treat any of these conditions:
- Pain in joints, like the knee and hip, caused by arthritis
- Spasticity— this is a condition whereby there is an increase in muscle tone, leading to pain and difficulty with balance and gait. Spasticity commonly occurs in children with cerebral palsy. This condition in children is treated by a surgical procedure known as selective dorsal rhizotomy, whereby the surgeon destroys or cuts the dorsal nerve roots. Thus the pain signals cannot be conveyed to the brain, leading to pain relief. Selective dorsal rhizotomy assists in improving balance and gait, calming down an overactive bladder, and relieving pain.
- Spinal pain— types of spinal cord pain that rhizotomy can treat include lumbar facet syndrome, pain in the neck, spinal pain because of cancers, and chronic discoid back pain.
- Trigeminal neuralgia— the trigeminal nerve conveys pain plus other emotions to your brain from your face. Trigeminal neuralgia leads to unexpected, sharp, shooting pain around the face when particular stimuli, such as exposure to cold or chewing, are present. Rhizotomy is performed for trigeminal neuralgia when medication and other treatment options fail to achieve pain relief. But it can cause numbness around the face.
- Other conditions impacting the peripheral nerves
Before you qualify as a rhizotomy candidate, your healthcare provider may suggest a medial branch block to reduce pain and subdue inflammation. The procedure for locating the right nerve to inject for the block also enables your physician to know what nerves they should target during the rhizotomy process. If a facet joint injection, medial branch block, or other therapy procedures do not sufficiently relieve your back pains, your doctor might recommend rhizotomy.
Preparing for Rhizotomy
Your healthcare provider will need you to take several medical tests to verify the diagnosis and ensure you will benefit from rhizotomy. For instance, they may recommend an MRI test if you experience spinal pain or trigeminal neuralgia.
You will additionally need to undergo other regular tests before rhizotomy. These tests include:
- Chest x-ray
- Blood tests such as blood group and hemoglobin
- ECG to ensure the proper functioning of the heart
- Urine tests
- Older patients may need to undergo a comprehensive heart evaluation
Most of the patients receive IV (intravenous) sedation. In that case, the doctor will instruct you not to drink or eat anything for a given period before the procedure. You will also require a friend or family member to take you home. Ensure your doctor knows all the medications you currently take, and inquire what medication you should and should not use before undergoing the procedure. If you take aspirin products or blood thinners, you may have to stop taking them temporarily before rhizotomy.
How the Procedure Is Conducted
Most rhizotomies are conducted under general anesthesia, although other procedures, such as facet rhizotomy may be performed under local anesthesia. Once you are under anesthesia, the surgeon will make a quarter-inch cut near the vertebral facet joint. Referring to an x-ray-generated image as guidance, the surgeon will pass a small needle via the cut until it is appropriately placed at the nerve tip where the pain originates. Afterward, the surgeon injects a numbing drug and transmits a radiofrequency current to the needle tip to burn the nerve root. The surgeon will repeat this process on other nerves if the pain originates from several sites.
Once the rhizotomy procedure is done, the doctor will remove the needle and place a bandage over the cut. Stitches are usually not necessary.
The surgeon will position you based on the kind of surgical procedure you will undergo. For instance, if you are experiencing lower back pain, the doctor will ask you to lie face-down with padding for your body parts. For glycerol rhizotomy, the doctor will require you to remain seated.
Rhizotomy lasts between thirty minutes and one hour. Most patients experience pressure but do not feel pain during the procedure.
Recovering From the Procedure
The doctor administers an anesthetic during the surgery, so the doctor will need to observe you for up to twelve hours after the procedure. The observation period is based on how much anesthetic was administered, your response to it, and whether the doctor administered IV sedation.
After the rhizotomy procedure, you can resume your work and usual activities the following day. However, you should avoid heavy lifting or strenuous activities for one or two days. You can take a shower, but you should avoid swimming, soaking in a hot tub, or bathing for the following twenty-four hours.
Your physician may also tell you the exercises you may perform to strengthen your back, and they could suggest other lifestyle changes, like stress management, to assist in keeping your back muscles relaxed.
You may experience mild bruising, soreness, swelling, or discomfort after the procedure. The discomfort might persist for some days to a few weeks. All you will need to manage this discomfort are over-the-counter pain relievers and an ice pack.
You can expect a gradual improvement of your previous pain level once you undergo the procedure. Maximum pain alleviation and full recovery might take a few weeks. Although rhizotomy does not entirely end back pains, you should experience a substantial increase in mobility and comfort that can last for several months or even one or more years.
Side Effects and Risks of Rhizotomy
The rhizotomy surgical procedure is generally safe. Risks and side effects are rare and are based on the type of procedure and the nerves on which it is performed.
- Glycerol/glycerin rhizotomy side effects and risks include nausea, infection, bleeding, a minimal possibility of sensory change (feeling numb), vomiting, and complications from anesthesia.
- Radiofrequency rhizotomy is more likely to cause sensory change (feeling numb) than glycerol rhizotomy.
- Other risks and side effects include weakness or dizziness, chills, fever, swelling, redness, and drainage at the injection site.
Call your doctor if you experience one or several of the side effects, risks, or symptoms mentioned above.
Complications After Rhizotomy
Complications after rhizotomy may include:
- Meningitis— the meninges are protective coverings of the spinal cord and brain. Meningitis is the inflammation or infection of the membranes.
- Spinal deformities such as sideward bending or excessive forward of the spinal cord might occur in rhizotomy procedures where laminectomies are performed in minors with cerebral palsy. Thus, the health care provider should examine the spine alignment regularly until the minor attains skeletal maturity.
- Difficulty chewing if rhizotomy is performed for trigeminal neuralgia
- Numbness and loss of sensation in the site of nerve distribution— anesthesia dolorosa might occur after damage to the trigeminal nerve, whereby you might feel numb in the face, accompanied by pain in the numb area.
Rhizotomy May Fail
Like many other procedures, rhizotomy is not 100% successful for 100% of the patients who have undergone it. A few patients may experience no substantial pain alleviation after the procedure. And those patients who achieve their desired pain alleviation may feel the pain slowly returning after some years as the nerves regrow.
You want to consult your physician to establish whether another form of rhizotomy, another treatment option, or a second rhizotomy procedure will achieve maximum pain alleviation should the pain return. Based on where your pain is coming from, other treatments may include decompression surgical procedures to move aside or remove tissues pressing on the nerves.
Find a Competent Neurosurgeon Near Me
Rhizotomy may be the surgical procedure you need to alleviate your chronic back pains. To know that, you need to consult an experienced spine specialist. Dr. George Rappard’s Clinic has some of the best spine specialists in Los Angeles. Get in touch with us at 424-777-7463 or visit our facility and we will answer all your questions and address your concerns regarding rhizotomy. We will also evaluate whether you are an ideal candidate before we embark on treatment.