Rhizotomy is the cutting of nerve roots as they enter the spinal cord.
Rhizotomy (also called dorsal rhizotomy, selective dorsal rhizotomy, and selective posterior rhizotomy) is a treatment for spasticity that is unresponsive to less invasive procedures.
Spasticity (involuntary muscle contraction) affects many thousands of Americans, but very few are affected seriously enough to require surgery for its treatment.
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.
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.
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.
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.
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.
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.
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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?