Rhizotomy

Rhizotomy is a procedure that is performed to prevent the movement of pain signals from an affected area of the body to the brain. This procedure involves the use of an endoscope or application of electric current or radiofrequency waves to disable the target nerves which leads to the blockage of pain signals and relief from chronic (long-term) pain.

This surgery is usually done on the facet joints. Facet joints are the coupled structures located at the back of the spinal bones. These joints assist in maintaining the flexibility of the spine and facilitate the forward or backward movement (flex) of the spine. A capsule of soft tissues filled with a fluid in between is located between each of these joints. This capsule protects the joints and helps in the efficient functioning of the joints. Facet joints also contain white-coloured cartilage that ensures their smooth working.

Wear and tear of cartilage or capsule due to age, or increase in the size of a joint puts the facet joints at risk of damage. When this happens, the nerves surrounding the joints send pain signals to the spinal cord, which are ultimately transferred to the brain, indicating joint damage.

Doctors suggest rhizotomy to stop these nerves from transmitting pain signals from the injured facet joint to the brain.

A surgeon may recommend rhizotomy if you have pain in your spine. This pain can occur because of the following reasons:

• Injuries like whiplash (an injury that occurs with sudden movements of the neck) 
• Cerebral palsy 
• Spinal arthritis (inflammation of the facet joints of the spine) 
• Nerve pain due to conditions like regional pain syndrome (chronic pain after an injury) or peripheral nerve entrapment syndrome (loss of flexibility or mobility by the peripheral nerve)
• Spasticity (tightening of muscles)

In children, particularly, this surgery is performed to improve their walking (gait) and functioning of legs.

Your surgeon may not opt for this procedure if you have an infection in the planned area of surgery or an increase in pressure inside your skull (intracranial). In some conditions, the surgery may be risky but can be performed by taking suitable precautionary measures (relative contraindications). Such circumstances include bacteraemia (presence of bacteria in the blood) or abnormality in the affected area since birth.

Before undergoing this surgery, you will need the following preparations:

• Your doctor will examine you thoroughly and ask you to undergo the following diagnostic tests:
  • Blood tests
  • X-ray
  • Electrocardiogram for assessing the electrical activity of heart 
  • Magnetic resonance imaging and ultrasound scans for a detailed view of the inner organs and structures 
• You will be required to share all the information concerning your present and previous medications with your doctor. This information should also include over-the-counter drugs, vitamins, herbs, minerals and supplements. Also, tell your doctor if you have used any antibiotic medicines in the past four weeks.
• Additionally, inform your physician if you have a bleeding disorder or are taking blood-thinning medicines. Your doctor may ask you to stop taking the latter a while before the surgery.
• You will be asked to start fasting at least six hours before the procedure.
• Tell your healthcare practitioner if you have had any illnesses, including fever, in the past four weeks.
• Ask someone, a friend or a family member, who can take you to and from the hospital for the surgical procedure. 
• On the day of the surgery, the healthcare staff or team will provide you with a consent form, which you will be asked to sign to confirm your willingness for the surgery.

The surgeon and his/her medical team will perform the following steps in this surgery:

• The medical staff will ask you to remove your ornaments or any other valuables and wear a hospital gown.
• You will be required to relax on your stomach for the surgery.
• An anaesthetist will administer local anaesthesia to you to remove any sensation in the surgical area. You may also receive general (to keep you asleep during the surgery) or spinal anaesthesia if needed.
• Once the surgical area is numb, then the surgeon will perform rhizotomy in one of the following ways:
• Radiofrequency ablation:
  • The surgeon will carefully inject the radiofrequency needle in the surgical site. This activity is monitored using x-ray scan. 
  • He/she will then pass electric current through a probe that is inside the needle to confirm the targeted nerve. At this time, the doctor may ask if you have any muscle twitching or tingling sensation. This phenomenon indicates that the correct nerve is affected. 
  • Once the electric probe and needle are correctly placed, the anaesthetist will administer you with more local anaesthesia. 
  • The surgeon will then heat the targeted nerve using radio waves until the pain signals from the affected area to the brain are restricted.  
  • The surgeon will then place a bandage over the injection site.
• Endoscopic rhizotomy: This procedure is done by inserting an endoscope to find the affected area and then cutting the target nerve root.

The duration for this surgery may vary depending on the targeted area. After the surgery, you will relax in a recovery room for about half an hour or more. During this period, the nurse will monitor your blood pressure and other vital signs. You may be able to go home on the same day as your surgery or the surgeon may decide that your condition needs to be monitored in the hospital for a while.

Once you are home, you will need to practice self-care in the following ways:

• Care of surgical area: 
  • In case of radiofrequency ablation, you may be allowed to remove the bandage on the next morning of the surgery. 
  • Your doctor may allow you to shower after the surgery. However, you must avoid bathing or sitting in the hot tub for at least two days after the surgery. 
• Diet: There may not be any restriction on your diet.
• Medications: 
  • Your doctor may prescribe a few painkiller medicines to reduce any post-surgical pain. He/she may also suggest you to apply a cold pack to reduce the swelling over the surgical area.
  • Your doctor will allow you to restart your blood-thinning medicines post-surgery after a proper assessment.
• Activities: 
  • Avoid driving for at least a day after the procedure.
  • You must not do strenuous activities until your doctor allows you to.
  • A physiotherapist may suggest you a few exercises to improve your movement after the surgery, which you must religiously follow for a quick recovery.

When to see the doctor?

You must call or visit your healthcare practitioner immediately if you experience the following symptoms after the surgery:

• Fever 
• Chills
• Severe pain at the injection site 
• Persistent numbness in legs or back  
• Sharp, stabbing pain or burning sensation at the surgical area 
• Trouble urinating
• Weakness in legs 
• Problem in moving legs 
• Cough 
• Persistent nausea or vomiting 
• Chest pain 
• Shortness of breath 
• Swelling at the surgical area

This surgery is known to cause the following risks:

• Infection 
• Nerve damage 
• Failure to provide pain relief 
• Allergic reaction to anaesthesia 
• Pain or discomfort 
• No long-term pain relief
• Soreness at the operated site 
• Burning at the surgical site

Your doctor will schedule your appointment again six to eight weeks after surgery. During your visit, he/she will check the effect of this procedure on your pain perception. If you show a positive response, then the doctor may schedule your visit again for further treatment.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.