Eight out of ten people suffer from back pain at some point during their lifetime. If your pain has persisted for more than 12 weeks, it is chronic, and you require relief. Spine-related pain will limit your physical abilities and affect your psychological well-being. Dr. George Rappard, a Los Angeles-based practice, is devoted to finding the most effective and minimally invasive therapy for you. Depending on your condition, the kind of pain you have, and what is causing it, the clinic can recommend rhizotomy surgery, which involves damaging the nerves that transmit pain signals to your brain.
Rhizotomy Surgery Overview
Your nerves transmit signals between your body and the brain. The signals assist you in moving muscles and feeling different sensations like touch and pain. Also, they maintain functions like digestion, sweating, and breathing. Rhizotomy surgery involves cutting problematic nerve roots that transmit pain to the brain, relieving pain.
Typically, rhizotomy is the last resort after more conservative treatments like nerve blocks, NSAIDs, and physical therapy fail to offer relief.
Rhizotomy is also known as neurotomy or ablation. These terms mean the deadening or removal of tissues.
Conditions Rhizotomy Surgery Treats
The various types of abnormal nerve activities and pain rhizotomy addresses include the following:
- Neck and back pain from spinal stenosis, herniated disc, arthritis, and degenerative spine health conditions. The treatment process for these ailments is called facet rhizotomy, which involves your nerves traveling via the spine’s facet joints. If the procedure is for nerves in the neck, it is called cervical rhizotomy, while the lower back procedure is called lumbar rhizotomy.
- Trigeminal neuralgia (facial pain due to trigeminal nerve irritation).
- Chronic headache.
- Postherpetic neuralgia affecting your face.
- Atypical face pain.
- Joint pain in the knee and hip caused by arthritis.
- Spasticity (atypical muscle spasms and tightness). The process disrupts movement patterns that cause specific muscles to contract when moving or resting. For spasticity due to cerebral palsy (CP), a treatment known as selective dorsal rhizotomy can boost communication between your muscles and spinal cord. Please note that not all children with CP are eligible for the surgery.
- Conditions affecting your peripheral nerves.
Different Categories of Rhizotomy Surgeries
There are many forms of rhizotomy surgical procedures. Depending on your nerve’s location, your surgeon can perform the procedure under local or general anesthesia and use an image-guided method like fluoroscopy or x-ray to ensure accuracy.
- Glycerol or glycerin rhizotomy — The procedure involves using a needle to inject glycerol or glycerin (a chemical) into the affected nerve’s root. The chemical can destroy your pain-transmitting nerve within an hour.
- Radiofrequency rhizotomy surgery — Also referred to as radiofrequency ablation, radiofrequency rhizotomy is identical to glycerin rhizotomy. However, instead of damaging your nerve fibers using chemicals, your physician will use a radiofrequency current to burn your fiber. It is common among individuals who do not receive pain relief from glycerol rhizotomy or who have recurring pain and require help via their scar tissues.
- Endoscopic rhizotomy — Your surgeon will use an endoscope (a camera) to find the problematic nerves and sever their fibers. Surgeons insert endoscopes via a tiny incision through a tubular retractor system. The doctor can get to your nerve without damaging healthy tissues and organs. The treatment procedure is also known as direct visualized rhizotomy.
Why the Rhizotomy Procedure?
Some of the benefits related to this procedure include the following:
- It can relieve pain, enhancing your quality of life.
- Enhances your range of motion and flexibility.
- The spinal cord is the most common location for this surgery, but it can also be performed on joints within the body. The procedure can reduce pain and enhance your ability to move the affected joint by severing the nerve root attached to it.
- Rhizotomy can reduce muscle spasms by cutting the signals causing them.
- It is a safe, minimally invasive, and efficient procedure.
Preparing for Your Rhizotomy Surgery
Since every rhizotomy has its own preparation process, the physician should inform you of what you should do.
Generally, healthcare providers will recommend tests to improve the procedure’s success rate. These tests include:
- Blood tests.
- Nerve block to locate the problematic nerve.
- Imaging test like an X-ray or magnetic resonance imaging (MRI) scan.
If your surgeon administers general anesthesia, they will schedule a medical appointment with an anesthetist to ensure safety. It can involve tests that check your cardiovascular health.
You should also stop taking specific medications like blood thinners (anticoagulants). Your healthcare team should tell you if this applies to you. Do not stop taking the medications unless advised to.
Remember to tell your surgeon about your medical history by highlighting the following:
- Any supplements and herbs you take.
- Your medications and their dosage.
- Treatments or medications you have used to treat the condition.
- Your previous surgical procedures and problems experienced, like vomiting and nausea.
Questions to Ask Your Surgeon Before the Surgical Procedure
Deciding to have rhizotomy surgery requires careful consideration and a solid understanding of the procedure and recovery process. Below is a thorough list of questions to ask the healthcare team before the surgical treatment:
- What is the recommended surgical procedure? — Your surgeon should explain why they recommend the procedure, the steps involved, and how it can relieve pain. Ask if there are various ways to perform the surgery and why they prefer one option.
- What are the pros and cons of a rhizotomy surgical procedure? — Your physician should highlight specific advantages of the surgical procedure and tell you how long they should last. Also, ask for published details regarding the treatment’s outcome. It will help you make informed decisions and have rational expectations.
- Does the surgery have potential complications and risks? — All surgeries carry risks, making it essential to weigh the advantages against the complications and risks before your procedure. Ask your doctor to highlight the potential complications. Ensure you understand when to seek immediate medical treatment or notify the physician about the complications. Remember to discuss post-op instructions and guidelines.
- What can you expect during your recovery? — Ask the physician what to anticipate in days, weeks, and months after surgery. You should know what restrictions the doctor will place on you and if there are special equipment or supplies you will require after your rhizotomy surgery. Knowing what to expect will assist you to manage and recover quickly. Remember to inquire about how long it takes to resume your daily routine and work.
- What is the total cost of rhizotomy surgery? — You should know your surgery’s cost and whether your health insurance provider will cover the treatment, and by how much.
- Can I ask you more questions later? — Your initial consultation can be overwhelming. Ask the physician if returning to or calling their office later with questions is okay.
To improve your communication with the healthcare provider, take notes, ask a loved one to accompany you, request the doctor to write down their instructions, and ask questions until you understand the doctor’s responses.
What to Expect During Your Surgery
Before the procedure, the healthcare team will ask you to change into a hospital gown, give you an ID bracelet, and insert an IV catheter.
You should fast overnight and drink intravenous fluids to keep hydrated.
The rhizotomy procedure varies based on the nerve your physician is targeting and the kind of surgery involved.
Generally, the procedure involves the aspects below:
- Sedation or general anesthesia — Many rhizotomy surgeries need general anesthesia (medications that numb the brain so you sleep and do not feel pain during your procedure). Other forms of rhizotomies involve the administration of local anesthesia or sedation (drugs to make you relax).
- Imaging guidance — Many surgeries use imaging guidance (fluoroscopy) to pin out the nerves and ensure your surgeon places the needle correctly. It can require using a contrast dye to show the nerves clearly on imaging. The doctor will inject the contrast dye via an intravenous (IV).
- Testing your affected nerve — During the surgery, the doctor will test your nerve with electrical stimulation to ensure accuracy. Depending mainly on the form of surgery, it can involve using electromyography or inserting a microelectrode via a needle to stimulate your nerve.
- Destroying your nerve — Depending on your form of rhizotomy, your doctor can use surgical cutting, chemical ablation, or radiofrequency ablation to damage your problematic nerve. Typically, physicians use needles to deliver radiofrequency and chemical ablations. Cutting your nerve will involve open surgery or an endoscopic surgical procedure.
What Occurs After the Surgery
If your doctor administered general anesthesia, you will be awake after the treatment, and the tube down your trachea will be removed. Before extracting the tubing, the physician will request you keep your eyes open. You can cough and experience nausea after the tube is removed.
The surgeon can insert a Ryle tube or nasogastric tube in the stomach to keep it empty.
Finally, a nurse will transfer you to the recovery room. They will monitor your vitals and observe you for an hour or two.
How Long Will Your Recovery Last? How Soon Can You Resume to Work?
Recovering from the surgery varies depending on the patient’s circumstances and the form of rhizotomy surgery. Nevertheless, most people can resume their routine within days following the procedure.
While you might experience discomfort, bruising at your incision site, or swelling, these symptoms will subside within days.
You should avoid strenuous activities like twisting and heavy lifting for weeks following the procedure to permit your incision site to recover properly. You should also engage in physical therapy (PT) to improve flexibility and strength at the surgery site.
The time it takes to resume work depends on your occupation and your job’s physical nature. Patients with physically demanding jobs should take weeks off to heal, while patients with sedentary jobs can return to work within days following the treatment. Ensure you discuss your plan with your physician to reduce your chances of reinjury and ensure you recover appropriately.
Side Effects and Potential Risks of the Surgery
The risks related to rhizotomy depend on the form of your procedure and the involved nerves.
Radiofrequency rhizotomy is more likely to cause sensory change (numbness) than chemical options.
Glycerol/glycerin rhizotomy risks include infection, vomiting, nausea, bleeding, anesthesia complications, and numbness.
Rhizotomy Success Rate
Like many surgical procedures, rhizotomy does not offer all patients a 100 percent success rate. A small percentage of patients might not experience pain relief. Also, the pain can gradually return when the nerve regrows after many years.
It is wise to consult with your surgeon to determine whether a second rhizotomy or another type of rhizotomy will offer pain relief if the pain recurs. Depending on your pain’s root cause, other treatment options include decompression surgery to remove or move tissues pressing on your nerve.
Exercising After Rhizotomy
Many patients are hesitant to start training programs or exercise after surgical treatment. Some patients do not feel pain after the procedure, while others can compromise their recovery if they overdo it too soon. Consult your physician to learn the safest activities and exercises.
Avoid strenuous activities or exercises for several weeks. Light exercises can promote recovery by preventing complications like blood clots and increasing blood flow.
The duration you can start exercising after treatment depends on whether you previously exercised regularly and your condition’s severity. Take things slowly if you are starting a training program or exercise routine. Listen to your body and put on compression stockings after and during workouts.
Exercises that can be vital to you after the surgery include the following:
- Stationary bike.
Some of the activities to avoid after the surgery to promote quick recovery and optimal results include the following:
- Standing or sitting for extended durations.
- Drinking alcohol.
- Wearing tight clothing around the treatment site.
- Crossing your legs.
- Wearing high heels after the procedure.
- Taking hot baths.
Find a Qualified Surgeon Near Me
Chronic back-related pain can result in reduced quality of life. Dr. George Rappard practice can offer individualized treatment from diagnosis through recovery and recommend conservative care options. If the conservative methods fail to provide relief, we can recommend rhizotomy, a minimally invasive surgical procedure. At our clinic, you receive comfort, convenience, and quality service; it is what you deserve and need for your back care journey. We have a level of experience unmatched by any other Los Angeles healthcare facility, and we use exclusive surgical techniques and patented equipment to offer relief and help you get back to living comfortably. Please contact our office at 424-777-7463 to schedule your medical appointment to learn how we can help you and get answers to your questions.