What is rhizotomy?
Rhizotomy is a minimally invasive surgical procedure used to numb an agonizing nerve by severing the nerve fibres responsible for transmitting pain signals to the brain. The nerve fibres can be obliterated by severing them with a surgical instrument or burning them with a chemical or electrical current. In most instances, rhizotomy provides immediate pain alleviation that can last for several years or until the nerve recovers and can transmit pain again.
Rhizotomy is also known as ablation and neurotomy; these terms all refer to the eradication or death of tissue.
What conditions can be treated with rhizotomy?
Rhizotomy can be utilized to treat various forms of pain and aberrant nerve activity, including:
- Back and neck discomfort is caused by degenerative spine conditions such as arthritis, herniated discs, spinal stenosis, etc. This treatment is known as facet rhizotomy because it involves the nerves that travel through the spine's facet joints.
- Trigeminal neuralgia — facial pain caused by trigeminal nerve irritation.
- Arthritis-related discomfort in joints, including the hip and knee.
- Other nerve disorders that affect the periphery.
- Spasticity (aberrant contraction and spasm of muscles). A procedure known as selective dorsal rhizotomy can help enhance communication between the spine and muscles in cases of cerebral palsy-related spasticity.
Types of Rhizotomy
There are various types of rhizotomy, all of which entail the destruction of the nerve fibres that transmit pain signals. Depending on the location of the nerve, rhizotomies may be performed under general or local anaesthesia and are frequently guided by X-ray, fluoroscopy, or another image-guided technique to ensure accuracy.
- Glycerin/Glycerol Rhizotomy
During this rhizotomy, a surgeon injects a small amount of a chemical (glycerine or glycerol) directly into the nerve root. In approximately 45 to 60 minutes, the chemical destroys the nerve's pain fibres.
- Radiofrequency Rhizotomy
Radiofrequency rhizotomy (radiofrequency ablation) is similar to glycerine rhizotomy, but instead of using a chemical to eliminate nerve fibres, a radiofrequency current is used to burn the fibres. Patients who do not receive complete pain relief from glycerine or who have recurrent pain and may require assistance to penetrate scar tissue frequently receive this medication.
- Endoscopic Rhizotomy
During endoscopic rhizotomy, a surgeon employs an endoscope, a camera-like instrument, to locate the affected nerve and cut its fibres. The endoscope is inserted through a small incision using a system of tubular retractor tubing. This enables the surgeon to bypass healthy organs and tissues while reaching the nerve. This method is also referred to as direct visualized rhizotomy.
Recovery After a Rhizotomy
The rhizotomy procedure itself only takes a few minutes. You will then spend several hours in the recovery area. You can return to work one or two days after the procedure, depending on how well you manage the anaesthesia.
It is common to experience pain, oedema, and bruising at the surgical site.
Risks and Side Effects of Rhizotomy
The risks of rhizotomy depend on the type of procedure and the nerves on which it is performed.
- Risks associated with glycerine/glycerol rhizotomy include bleeding, infection, vertigo, vomiting, a slight possibility of sensory change (numbness) and anaesthesia complications.
- Chemical rhizotomy has a lower likelihood of causing sensory changes (numbness) than radiofrequency rhizotomy.
