Rhizotomy is a minimally invasive pain relief procedure that involves killing the nerve fibers that send pain signals to the brain to remove sensation from a painful nerve. The doctor can destroy the nerve fibers by burning them with chemicals or an electric current or by severing them using a surgical instrument. Usually, rhizotomies offer instant pain relief, and the results could last for years until the nerve fully recovers and can send pain signals again. Rhizotomy is also known as neurotomy or ablation. These terms describe the process of deadening and removing tissue. If you struggle with pain and are considering a rhizotomy procedure in Los Angeles, Dr. George Rappard can assist.
Rhizotomy involves damaging selective nerve fibers to treat spasticity or chronic pain. Medical providers can use several methods to damage the nerve fibers:
- Using a surgical instrument to cut the nerve fibers — Surgeons can perform this procedure using the endoscopic approach or open surgery, like selective dorsal rhizotomy. The endoscopic approach involves making a tiny incision and using a tiny camera tool to find and damage the nerves.
- Damaging the nerves using a chemical like glycerol or glycerin — With this procedure, the surgeon uses a needle to administer a small amount of chemical (glycerol or glycerin) to the root of the target nerves. The chemical damages the nerve's pain fibers for 45 to 60 minutes.
- Burning the nerves using high-intensity radio waves is a procedure known as radiofrequency ablation. Radiofrequency rhizotomy is like glycerin/glycerol rhizotomy, but the doctor uses a radiofrequency current instead of a chemical to damage the nerve fibers. Radiofrequency rhizotomy is ideal for patients with recurring pain, patients who do not enjoy complete pain relief from glycerin, or patients who require assistance to get through the scar tissue.
Nerves act like cables that transmit electrical signals between the brain and other body parts and vice versa. These signals enable you to experience sensations like pain and touch and allow you to move your muscles. The nerve signals also maintain bodily functions like sweating, breathing, or digesting food. When your doctor destroys the problematic nerves during rhizotomy, the nerves no longer send pain signals to your brain, offering pain relief.
The Difference Between Rhizotomy And Ablation
Rhizotomy and nerve ablation serve the same purpose of damaging the nerve tissues that cause pain or other health problems. Rhizotomy is the umbrella or collective term. There are several forms of ablation: radiofrequency ablation involves using heat to damage the nerves, while chemical abrasion involves using a toxic substance to damage the nerve.
Healthcare providers often use the term neurotomy instead of nerve ablation or rhizotomy.
Conditions That Can Be Treated With Rhizotomy
Rhizotomy can be used to treat a wide range of conditions characterized by abnormal nerve activity and pain. Some of the conditions that can be treated using rhizotomy include:
- Back and neck pain is caused by herniated discs, arthritis, spinal stenosis, and degenerative spinal conditions. Facet rhizotomy addresses these conditions by involving nerves that travel through the facet joints in the spine.
- Pain in joints like knees and hips due to arthritis.
- Trigeminal neuralgia is facial pain resulting from the irritation of the trigeminal nerve.
- Spasticity, which is abnormal spasms and muscle tightness. Selective dorsal rhizotomy can help to relieve spasticity resulting from cerebral palsy. Selective dorsal rhizotomy improves the communication between the muscles and the spine.
- Other conditions that affect the peripheral nerves.
Types Of Rhizotomy
Different types of rhizotomies treat different causes of spasticity and chronic pain. Rhizotomies target different nerves to treat specific types of pain. Usually, doctors do not recommend rhizotomy as the first remedy for pain. Instead, they recommend conservative treatments like nerve blocks, NSAIDs, or physical therapy. The different forms of rhizotomy are:
This treatment focuses on the nerve roots that pass through the facet joints in the spine. Facet rhizotomy treats pain caused by conditions that affect the spine, including facet joint syndrome and arthritis. The treatment is effective in treating lower back and neck pain.
If doctors perform a rhizotomy on the nerves in the neck, they may call it a cervical rhizotomy. If the procedure is performed on the nerves in the lower back, it is known as a lumbar rhizotomy.
Trigeminal Ganglion Rhizotomy
This procedure focuses on the nerves in the trigeminal ganglia. These are nerve clusters on the sides of your face. Trigeminal ganglion rhizotomy can help with the following:
- Treating chronic treatment-resistant headaches.
- Trigeminal neuralgia.
- Cancer-related pain affecting the face.
- Postherpetic neuralgia affecting the face.
- Atypical face pain is also known as idiopathic facial pain.
Trigeminal ganglion rhizotomy, or percutaneous rhizotomy, is performed through the skin.
Selective Dorsal Rhizotomy
This procedure is effective in treating spasticity in children suffering from cerebral palsy. Spasticity is a disruption or disorder of the muscle movement patterns whereby some muscles contract all at once when you move or even when resting. Selective dorsal rhizotomy targets certain nerves in the lower spinal cord. However, not all children with cerebral palsy are good candidates for selective dorsal rhizotomy.
How To Prepare For A Rhizotomy Procedure
The required preparation process will depend on the type of rhizotomy you intend to undergo. Your doctor will advise you on what to do before the procedure. You should feel free to ask questions to ensure that you know what to expect.
Usually, healthcare professionals recommend several tests to ensure that the rhizotomy treatment is ideal for a patient. The tests include the following:
- Blood tests.
- Imaging tests like X-rays and MRI scans.
- Nerve block to identify the problematic nerves.
You will have an appointment with the anesthesiologist if you need general anesthesia during the procedure. The anesthesiologist will ensure the process is safe by conducting tests to determine your heart's health.
Before the treatment, your doctor could instruct you to stop taking certain medications, like anticoagulants (blood thinners). However, you should not stop taking your medication until your doctor advises you to. Your provider will tell you whether you should continue or stop taking medication.
Your doctor will perform all the necessary diagnostic tests to locate the nerve causing the pain. Your doctor could also request imaging records for any reviews you have undergone. You can follow the following steps to prepare for the procedure:
- Avoid taking aspirin two weeks before your treatment since it causes blood thinning.
- Stop taking other blood thinning medication, ideally five days before the procedure.
- Avoid taking anti-inflammatory medication a minimum of five days before the treatment.
- Your physician will review all the medications you are taking.
- Avoid eating, drinking, or taking pain medication four hours or more before the treatment.
- You should have a friend or family member to drive you home after the treatment.
During a Rhizotomy
What should you expect during the actual rhizotomy?
This will depend on the type of rhizotomy you are undergoing and the nerves your healthcare provider targets. Usually, conducting rhizotomy through surgical cutting differs from chemical ablation or radiofrequency ablation.
In general, here is what you should expect during a rhizotomy:
Sedation Or General Anesthesia
In most cases, patients are under general anesthesia when undergoing rhizotomy. You will be under medication that numbs your brain, making you fall asleep so you don't experience pain and discomfort during the procedure. However, some rhizotomies only require sedation (sedation medication makes you relax) or local anesthesia.
Testing The Affected Nerves
Your doctor will test the affected nerves during a rhizotomy procedure. Medical professionals use electrical stimulation to help them identify the target nerves. Testing could involve inserting a microelectrode via a hollow needle to stimulate the nerves, depending on the type of rhizotomy. Testing could also include using electromyography, abbreviated as EMG.
Most rhizotomies involve fluoroscopy or imaging guidance to identify the problematic nerves and ensure the doctor places the needle in the right spot. This process could entail using a contrast dye to make the nerves show up better in the imaging. Contrast dye is a safe product administered through an IV.
Destroying the Nerves
Depending on the rhizotomy type, the medical provider could use surgical cutting, radiofrequency ablation, or chemical ablation to destroy the problematic nerve. Doctors use needles to perform radiofrequency and chemical ablations. Surgical nerve-cutting could involve endoscopic surgery (making a small incision) or open surgery (making a large incision).
What To Expect After A Rhizotomy Procedure
Doctors use anesthesia during a rhizotomy procedure so that you will be observed for up to 12 hours post-treatment. The applicable observation time will depend on how much anesthesia is used, your response to anesthesia, and whether the medics administer IV sedation.
You could be wondering whether rhizotomies are painful. Usually, every patient is unique and has a unique experience during treatment. If you are concerned about experiencing pain or are anxious about the rhizotomy procedure, your doctor could recommend sedation. The observation time is shorter if IV sedation is not involved. You can choose IV sedation to minimize the pain and discomfort experienced during the treatment.
Here are some of the side effects that you can experience following a rhizotomy treatment:
- The back pain could recur after a week when the anesthesia wears off and your wound is still healing.
- You could develop some bruising or swelling at the injection site.
- You should experience chronic pain relief within four weeks of the rhizotomy treatment.
Following the rhizotomy treatment, your doctor could recommend physical therapy to strengthen your core muscles and back. Your nerves will grow back even after damage. Therefore, it is crucial to improve back and core muscle strength. The pain is less likely to recur when you have a strong back, and you will not have to undergo repeat surgery. Usually, rhizotomies offer pain relief for up to 12 months.
Possible Risks and Complications of Rhizotomy
Like any other medical procedure, rhizotomy has potential risks and complications. The good news is that a rhizotomy procedure does not pose significant risks or complications for the patient. Some of the risks involved include the following:
- Allergic reactions to medication or IV sedation.
- Discomfort at the injection site.
- Temporary leg or arm muscle numbness or weakness because of the anesthesia.
The risks and complications following a rhizotomy vary depending on the type of procedure and the nerves your doctor treats. Doctors expect certain side effects and do not refer to them as complications. For example, losing facial sensation after a trigeminal rhizotomy is normal. Your doctor will advise you on the procedure and the potential risks and complications.
The above potential rhizotomy risks and complications are rare, but the consequences can be severe if they happen. You should seek medical attention immediately if you experience adverse symptoms following a rhizotomy procedure. You need immediate medical attention if the injection site seems infected, you develop arm or leg weakness that persists and does not get better after eight hours, you have severe pain at the injection site, or your back pain worsens.
You should also consult a doctor immediately if you develop a fever and chills or start vomiting after rhizotomy. You also need immediate medical attention if you develop a bowel or bladder dysfunction.
The Effectiveness of Rhizotomy
You can benefit from rhizotomy, provided you are a good candidate for the treatment. It could take between two and four weeks for the pain to improve. However, when you finally get full pain relief, you can enjoy your life and participate in your favorite activities again.
A rhizotomy procedure can help treat different causes of chronic pain. Doctors reserve rhizotomy as the last resort when all other pain relief treatments are ineffective. Before recommending a rhizotomy, your doctor will likely recommend physical therapy and pain medication. Even if rhizotomy is an effective pain relief option, it is not for everyone. You should consult your doctor to determine whether rhizotomy is ideal for you. If you need rhizotomy services in Los Angeles, we invite you to contact Dr. George Rappard. Call us at 424-777-7463 to speak to one of our experts.