Rhizotomy



Definition

Rhizotomy is the cutting of nerve roots as they enter the spinal cord.


Purpose

Rhizotomy (also called dorsal rhizotomy, selective dorsal rhizotomy, and selective posterior rhizotomy) is a treatment for spasticity that is unresponsive to less invasive procedures.


Demographics

Spasticity (involuntary muscle contraction) affects many thousands of Americans, but very few are affected seriously enough to require surgery for its treatment.


Description

Rhizotomy is performed under general anesthesia. The patient lies face down. An incision is made along the lower spine, exposing the sensory nerve roots at the center the spinal cord. Individual nerve rootlets are electrically stimulated. Since these are sensory nerves, they should not stimulate muscle movement. Those that do (and therefore cause spasticity) are cut. Typically, onequarter to one-half of nerve rootlets tested are cut.


Diagnosis/Preparation

Rhizotomy is performed on patients with spasticity that is insufficiently responsive to oral medications or injectable therapies (botulinum toxin, phenol, or alcohol). It is most commonly performed for those patients with lower extremity spasticity that interferes with walking or severe spasticity that prevents hygiene or positioning of the legs. It is most commonly performed on children with cerebral palsy.

Patients undergoing rhizotomy receive a large battery of tests before the procedure, in order to document the functional effects of spasticity, and the patient's medical health and likely response to anesthesia and other operative stresses. Rhizotomy is performed as an in-patient procedure, and the patient is likely to require an overnight hospital stay before the operation.


Aftercare

After surgery, the patient will spend one to several days in the hospital. Physical therapy and strength training usually begin the next day, in order to maximize the gains expected from surgery, and to keep the limbs mobile. Medication may be given for pain.


Risks

Rhizotomy carries small but significant risks of nerve damage, permanent loss of sensation or altered sensation, weakness of the lower extremities, bowel and bladder dysfunction, increased likelihood of hip dislocation, and scoliosis progression. Anesthesia carries its own risks.


Normal results

Rhizotomy reduces spasticity, which should allow more normal gait and improve mobility. Patients may require fewer walking aids, such as walkers or crutches.

Morbidity and mortality rates

Other than the risks from anesthesia, rhizotomy does not carry a risk of death during surgery. Morbidity rates vary among centers performing the surgery. Persistent and significant adverse effects may occur in 1–5% of patients, including bowel or bladder changes and low back pain.


Alternatives

Other spasticity treatments include oral medications and an implanted pump delivering baclofen to the space around the spinal cord (intrathecal baclofen). These may be appropriate alternatives for some patients. Orthopedic surgery can correct deformities that occur from untreated spasticity. Some controversy exists whether rhizotomy can delay or prevent the need for other spasticity procedures, especially orthopedic surgery such as tenotomy , with some evidence suggesting it can, and other evidence suggesting it may not.


Resources

organizations

United Cerebral Palsy. 1660 L Street, NW, Suite 700, Washington, DC 20036. (800) 872-5827 or (202)776-0406. TTY: (202) 973-7197. Fax: (202) 776-0414. webmaster@ ucp.org. http://www.UCP.org .

WE MOVE. http://www.wemove.org .


Richard Robinson

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Rhizotomy is performed by a neurosurgeon in a hospital. The patient's neurologist and physical therapist may also be in attendance to help with the evaluation during surgery.

QUESTIONS TO ASK THE DOCTOR



Also read article about Rhizotomy from Wikipedia

User Contributions:

1
Pam barrett
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Jun 18, 2007 @ 9:09 am
My mother just had this done out patient. There is no talk of therapy or anything else, it is just a wait and see situation. This was done under florsocopy,buy a suregeon, but what are thr long term affects?
2
Lord Chester
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Nov 24, 2007 @ 7:19 pm
THIS DOCUMENT HAD NO ASSESSMENT AND FROM PHILIPPINE I AM SURGEON
3
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May 16, 2011 @ 11:23 pm
WHAT IS THE NAME AND MANUFACTURE OF THE MACHINE THAT WE ARE USING DURING THIS PROCEDURE?
4
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Dec 31, 2011 @ 12:00 am
If the patient, *self*, is sedated, but not underandesthia, for facet (lumbar) rhizotomy, how long is the electrical current, and for how long, is the original pain "amplified." My pain without this is so bad, I'm terrified at the amplification of it...how long does each nerve last...the lesion created...and what are they likely to use for sedation. (nursing background/medical here) but terrified of amplification of the pain.
5
Penelope Coridan
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Mar 23, 2012 @ 5:17 pm
I had rhizotomy today, dealing with discomfort and tolerable as have worse back/groin/thigh /foot pain on a near daily basis.I'm totally traumatized tonight by procedure,the pain and sensations etc not advised and told about.Severe sensation in anal,perineum and vagina which i didn't know could happen on sacral nerve stimulation.It savage!!I don't mind if it works for me, but would prefer more information.I have procedure done without sedation as told more accurate!But all websites I read say mild sedation given.Ir would certainlyntake edge off barbarity of procedure.Any suggestions or opunions..
6
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Jun 8, 2012 @ 2:14 pm
I am a 63y/o female. I had a benign tumor removed from my spinal column 11 years ago, which left me paralyzed from the waist down. I have chronic leg and back pain and severe rigidity. My doctor has suggested a selective rhizotomy. I have a Balofen Pump which also has small dosages of Morphine in it. I have been taking oral doses of Balofen as well. The last thing that my doctor tried was injecting Botox into the leg muscles. All of these methods have seemed to only decrease the pain and rigidity for short periods of time. I also feel I have developed a tolerance to the Balofen. I am aware of some the outcomes I may face with the rhizotomy, but I am to the point I have to have a method that will have a lasting effect due to my severe pain! Would the selective rhizotomy be a positive step for me to take?
7
Gail White
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Aug 13, 2012 @ 6:18 pm
My retarded daughter has spascitity affecting her thighs. She was born without hip socket and we had surgery and hip sockets were made. Because of spascity she is slow and short gait. Would selective rehizotomy help? Thanks
8
kefilwe morake
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Oct 10, 2012 @ 5:05 am
IDID RHYZOTOMY DECEMBER 2010 DUE TO BACK AND HIP PAIN(DISLOCATION),AFTER SURGERY I EXPERIENCED LESS PAIN BUT NOW I AM EXPOERIENCING MORE PAIN THAN BEFORE,DO I NEED ANOTHER SURGERY?
9
KEFILWE
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Dec 1, 2012 @ 3:15 pm
I had an accident 2 years back and injured my hip and spinal chord,i did rhyzotomy december 2010,now i am experiencing same pains that i did after an accident,is something wrong,do i need anather surgery?
10
christina
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Dec 20, 2012 @ 8:08 am
I jus had a rizotomy done 2days ago... Following a car accident a year ago,my doctor told me they usually last for about a year,than I would need another one. So far my back feels wonderful!
11
Donna S
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Feb 6, 2013 @ 4:16 pm
I've searched and searched but cannot find any definitive information concerning an occipital rhizotomy for my neck. I am also looking for information concerning the entire process: Will I have general and/or local anesthetic, or be in a twilight state? Can I return to work the next day? Does the procedure actually sever the nerves or just block them for a while? Any help or information appreciated! Thanks!
12
nicole
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Sep 9, 2013 @ 7:19 pm
I was in a horrible car accident dec 2012 I have done phys. Therepy multiple injections
And now tomorrow I am facing a razodamey I have heard horrifing stories less great ones needless to say I'm freaking and I hope this works =/
13
Alice
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Aug 22, 2014 @ 3:15 pm
Is this done as an out patchin or do u stay in hospital
14
Beth
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Sep 3, 2014 @ 3:03 am
I have a lower back Facet joints + C1 rhizotomy coming up in a few weeks. I've had several injections in those areas but they only last for about 2 weeks. The DR. tells me that this will last a lot longer but the pain after will be worse for awhile. He will be giving me about 16 injections. Before the procedure he will be giving me 20 mg. of valium. I don't think that's going to be enough. He does the injections just like normal with the florascope and all but I barely make it through with 15mg of valium. Should I ask for more valium? I have a driver and I still don't think the 20 mg will be enough. I have a high tolerance for pain meds, if it's too much pain, i'm afraid i'll have a panic attack. Should I ask for more valium?
Thanks, Beth
15
AUDREY
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Nov 3, 2014 @ 1:13 pm
My mom is 82 years old, she have been suffering with back pain, she was diagnose with Lumbar Stenosis.She had one epidural injection, and it gave her some relief for about 1 week. She went back to see her Neurosurgeon for a follow up, he suggested
Rhizotomy and then Physical Therapy. My mom will not have surgery. My have no other medical problems, just the back pain. She live alone and very independent and she is very active. Do you believe this procedure will help her. My mom is afraid of any thing to do with hospital and surgery.
16
Julie
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May 10, 2015 @ 2:14 pm
I had a rhizotomy almost a year ago. Prior I asked about possible side effects. I was told that I may have numbness in patches on my back.
This did not concern me, with the amount of pain I was in. After the procedure I now have bladder problems, bowel problems and poor digestion. If I could turn the clock back, I never would have had this procedure. I am currently on 900 mg daily of gabepentin which makes life tolerable.
17
Lynn GC
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Jul 13, 2015 @ 12:00 am
I've recently undergone a Rhizotomy and it was after undergoing countless injections, PT, meds galore. I'm pleased with the outcome and I opted out of sedation. I'm 58 soon to be 59 and I look forward to the next chapter of my life pain free. If I have to undergo it a year from now I would gladly go for it. I'm going to be job hunting soon. Retired after 30+ yrs of working. All of my problems arose after being the victim of a hit & run, I was a pedestrian at the time. Went in shock and didn't believe the ppl who wanted to call paramedics. It happened on 2004, so I have been suffering since then, from dr to dr. Finally fate led me to the Pain Institute and I had left done 1st and two weeks later right where nerves were burnt. Had some pain right side more do than left but I'm pleased to say, no regrets. Planning on wearing my heels again, so tired of flats. Hope this helps anyone deciding on having reservations. It worked for me and I was on morphine, didn't help. Good luck and God bless.
18
Hettie Steyn
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Aug 29, 2015 @ 6:06 am
I have undergone the Rhizotomy procedure in 2011, the back and leg pain are back. Do I have to go through the whole procedure again? I am 69 years of age.
19
Susan Murry
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Oct 1, 2015 @ 11:23 pm
My doctor has suggested a rhizotomy. I am forty seven and have been in extreme pain since 2004. I have been treated with pain meds, physical therapy and injections and I still have pain. I was reinjured in April, so the pain has been intolerable. I have two bulging disc and an annulus tear. After, reading some of the comments I am more concerned and confused about the procedure. Can someone please help?!!
20
Jane Waldoch
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Dec 31, 2015 @ 12:12 pm
I have daily migraines and so far nothing has given me relief. They have lasted 9months. I am still afraid of side effects of a cervical rizotomy. Can you give me any advice?
21
Matthew
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Jan 15, 2016 @ 3:15 pm
Hi all, I just had this procedure done on my lumbar section yesterday. I was under sedation, but not anesthesia. Something important I want to call out, the pain amplification was not even discussed when talking about to procedure with the provider doing the Rhizotomy. Even on fentanyl and some benzodiazepine (no sure what is was) the pain was almost unbearable. Every other word out of my mouth was a swear word. It literally felt like I was getting stabbed in the back for 5-10 seconds at a time over the course of the entire hour long procedure. Please discuss the pain component associated with this procedure before committing to this. I was told I would experience "mild discomfort". This was a gross understatement of epic proportion.

Hope this helps!
22
Matthew
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Jan 18, 2016 @ 9:09 am
Hi all, I just had this procedure done on my lumbar section yesterday. I was under sedation, but not anesthesia. Something important I want to call out, the pain amplification was not even discussed when talking about to procedure with the provider doing the Rhizotomy. Even on fentanyl and some benzodiazepine (no sure what is was) the pain was almost unbearable. Every other word out of my mouth was a swear word. It literally felt like I was getting stabbed in the back for 5-10 seconds at a time over the course of the entire hour long procedure. Please discuss the pain component associated with this procedure before committing to this. I was told I would experience "mild discomfort". This was a gross understatement of epic proportion.

Hope this helps!
23
Yvonne Nairm
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Jan 19, 2016 @ 7:19 pm
I have terrible lower back and left leg pain ( leg shin cut in half and surgeon bent my leg 14% when he put in steel rod). Just had an MRI on lower back 4 days ago and meet with neorosurgen tommow. After reading all these comments I am sure going to ask surgeon a ton of questions! Wow! I was told by my neurosurgeon that it is a simple procedure and then told in and out in one hour!! I read here most had to stay in hospital and most are in more pain than before. I take 900 mgs. And some days more plus 10 mg cyclobenzaprine 6-7 per day. Does not do a thing. Supposed to. Have nerves burned and he said only 40% chance it will work!! Will have second surgery late on top spine all vertebrae twisted. &nerves wrapped around them. Body so full of osteoarthritis so that surgery. Only 50% chance. So far no. Upper. Pain but hope the first one is soon as can't walk more than 100 ft with out sitting or leaning on somerthing. I am a 69 year old woman and I wood love to be able walk my dogs and go picking huckleberries with my boyfriend 🙏🙏🙏
24
Mary Jane Curtis
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Feb 13, 2016 @ 10:10 am
Had an exam yesterday in West Palm Beach whee a pain management specialist is recommending this Rhizotomy for my crushed SI joint. I had a fall from my horse in 2014 and subsequently had the the SI incorrectly treated by a physical therapist here in Tampa literally pulling the SI apart. I am not seeing enough positive reports here to even consider the procedure. Pain in left butt check (for lack of better terminology) never stops. I would appreciate hearing if any of you have had ANY "delayed" positive reports post op to this procedure. Thanks so much and God bless. No one knows what pain is until you have had this pain 24/7/365.
25
louis
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Feb 24, 2016 @ 4:04 am
About 6 years ago,I had the option to undergo back surgery, but was referred to a neurosurgeon that performed a rhizotomy on my lower back. Since then ( after 3-4 days) my quality of life changed drastically. At the age of 59, I am still enjoying golf and off -road motorcycling as my passions in life, witch I could not perform before the operation. I can recommend the almost painless procedure with NO rehabilitation afterwards!
26
Leslie D Grossheim
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Mar 26, 2016 @ 5:17 pm
50 year-old female. Had a rhizotomy on Tuesday, 4 days ago. I've struggled with severe back pain due to severe arthritis in my lumbar/sacral spine. I did 2 injections of just a numbing agent since I'd previously had plain steroid injections which did not help. I'm currently on Percocet for the pain but I feel I need something stronger. I did not have any sedation, just the numbing of the skin prior to the injections. I felt all 6 injections and they were painful. I can say I have been in misery since the procedure but I am hoping it's just the numbing stuff wearing off before the steroid kicks in. Otherwise, I am demanding a stronger pain med. I was also very nauseated for 3 days and wanted to sleep a lot. No way I can go back to my lifestyle like it was before the procedure.
27
Blayne PARKER
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Apr 17, 2016 @ 12:12 pm
I had the rhizotomy 3 weeks ago, the procedure was terrible and incomprehensible pain, I had no anesthesia and was not offered any, this was done in the office of a pain management, the pain subsided for about 4 days, then it became even more excruciating, and now new pain is occurring in my hands and knees is don't know if this is coincidental or a side effect, but I feel like I should change my address to my hospital as I seem to spend more time there than home, pain medication only lasts for so long, I'm taking more than prescribed and I know this isn't the answer either. If I could only go back in time I would've kept up with the Steroid injections, at least I was getting some relief. be well prayers to you all!
28
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Apr 21, 2016 @ 9:09 am
My son had a rugby injury which left his neck in constant pain for the last 10 years, He had a rhizotomy done on Friday last week. He is in so much pain and taking pain killers to alleviate his pain, He is worse of now than what he was before the procedure. Is this the norm.
Regards May
29
CATHY
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Jun 23, 2016 @ 10:10 am
I had the rhizotomy on my lumbar spine earlier this year. Feeling GREAT. Most of my pain is gone. The nerves will regenerate normally within 6 months to a year. If my pain comes back I won't hesitate to have it repeated. My Dr. did both sides of my back and I felt a lot of the pain when the right side was done, but when I had the left side done I felt hardly any pain. I have multiple problems in my spine and for me the relief I have experienced was well worth the pain.
30
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Jul 6, 2016 @ 4:04 am
I have been diagnosed with cervical disk damage since 2004. The pain got severe last year and a CT scan revealed more damage to the disk and have been on pain meds, muscle relaxants, intermittent traction and physiotherapy for over 6 months now. I am seeing my orthopaedic surgeon for another review next week but my phisiotherapist is considering rhizotomy. After reading some of the comments above I am so confused as to whether I should even consider it or live with the pain that I am used to.
31
Avis Reynolds
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Aug 22, 2016 @ 3:15 pm
Scheduled for next month was told of some discomfort nothing like the pain described above but will be asking many questions prior to actual procedure.thanks to all for the input will post experience post procedure
32
alma koss
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Oct 15, 2016 @ 10:10 am
what kind of sedation will be used n me? I see from comments there could be a lot of pain during procedure and one may have to be in hospital...what is my case? alma koss
33
nancy smith
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Dec 1, 2016 @ 1:13 pm
what kind of rhizotomy would be required with pain from an injured tail bone? Thank you.

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