What is rhizotomy?

Rhizotomy is a minimally invasive surgical procedure to remove sensation from a painful nerve by killing nerve fibers responsible for sending pain signals to the brain. The nerve fibers can be destroyed by severing them with a surgical instrument or burning them with a chemical or electrical current. In most cases, rhizotomy provides immediate pain relief that can last up to several years until the nerve recovers and is able to transmit pain again.

Rhizotomy can also be called ablation or neurotomy — all of these terms describe removal or deadening of tissue.

What conditions can be treated with rhizotomy?

Rhizotomy can be used to address different types of pain and abnormal nerve activity, such as:

• Back and neck pain from arthritis, herniated discs, spinal stenosis and other degenerative spine conditions. The procedure for these issues is called facet rhizotomy, as it involves the nerves traveling through the facet joints of the spine.
• Trigeminal neuralgia — facial pain due to the irritation of the trigeminal nerve.
• Pain in joints, such as the hip and knee, resulting from arthritis.
• Other conditions affecting the peripheral nerves.
• Spasticity (abnormal muscle tightness and spasms). For spasticity caused by cerebral palsy, a procedure called selective dorsal rhizotomy can help improve communication between the spine and muscles.

Types of Rhizotomy

There are several types of rhizotomy, all of which involve destroying the fibers within a nerve that carry pain signals. Depending on the location of the nerve, rhizotomies can be performed under general or local anesthesia and often use X-ray, fluoroscopy or another image-guided technique to ensure precision.

Glycerin/Glycerol Rhizotomy

With this type of rhizotomy, a surgeon uses a needle to deliver a small amount of a chemical (glycerin or glycerol) to the root of the affected nerve. The chemical destroys the pain fibers in the nerve over the course of 45 to 60 minutes.

Radiofrequency Rhizotomy

Radiofrequency rhizotomy (also known as radiofrequency ablation) is similar to the glycerin rhizotomy, but instead of using a chemical to destroy the nerve fibers, a radiofrequency current is used to burn the fibers. It is often used for patients who do not get complete relief from glycerin or those who have recurrent pain and may need assistance to get through scar tissue.

Endoscopic Rhizotomy

With endoscopic rhizotomy, a surgeon uses a camera device called an endoscope to locate the affected nerve and sever its fibers. The endoscope is inserted through a small incision via a series of tubes called a tubular retractor system. This allows the surgeon to get to the nerve while bypassing healthy organs and tissues. This procedure is also called direct visualized rhizotomy.

Recovery After a Rhizotomy

The rhizotomy itself takes only a few minutes. Afterward, you will spend several hours in the recovery room. Depending on how you handle the anesthesia, you may be able to return to work one or two days after the procedure.

It is common to experience pain, swelling and/or bruising at the surgical site.

Risks and Side Effects of Rhizotomy

The risks associated with rhizotomy depend on the type of the procedure and which nerves it’s performed on.

• Glycerin/glycerol rhizotomy risks include bleeding, infection, nausea, vomiting, a small chance of sensory change (feeling of numbness) and anesthesia complications.
• Radiofrequency rhizotomy has a higher likelihood of causing sensory change (feelings of numbness) than the chemical method.

What if rhizotomy doesn’t work?

Like most procedures, rhizotomy doesn’t offer a 100% success rate for 100% of patients who undergo it. A small percentage of people may feel no significant pain relief after rhizotomy. And those who do get the desired pain relief may experience the pain gradually returning after several years as the nerve regrows.

It’s best to consult with your doctor to determine whether a second rhizotomy, another type of rhizotomy or another treatment will offer the most pain relief if the pain comes back. Depending on the origin of your pain, other treatment options could include decompression surgery to remove or move aside tissues pressing on the nerve.