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



  • How many rhizotomies have you performed?
  • What is your complication rate?
  • Is orthopedic surgery still likely to be necessary later on?

User Contributions:

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?
Lord Chester
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Nov 24, 2007 @ 7:19 pm
THIS DOCUMENT HAD NO ASSESSMENT AND FROM PHILIPPINE I AM SURGEON
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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?
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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.
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..
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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?
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
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?
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?
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!
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!
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 =/
Alice
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Aug 22, 2014 @ 3:15 pm
Is this done as an out patchin or do u stay in hospital
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
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.

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