Rhizotomy surgery destroys nerve roots.
The surgical procedure, rhizotomy, is meant to “sever nerve roots in the spinal cord” to provide patients with relief from muscle spasms or chronic back pain. The facet rhizotomy, for example, is meant to alleviate lower back pain by “disabling the sensory nerve at the facet joint”. This type of surgery would benefit patients who respond favorably to facet injections.1 The neurosurgical rhizotomy procedure is a technique used in patients with neuromuscular problems such as spastic cerebral palsy or spastic diplegia. In fact, the selective dorsal rhizotomy, or SDR, “has been the main use of rhizotomy for neurosurgeons” for treating spastic cerebral palsy for decades. Lately, the terms neurotomy and rhizotomy are being used interchangeably when describing treatment for the chronic back pain that is due to degenerative disc disease. For these type of conditions, the facet rhizotomy is the procedure that is performed, and it is done for outpatients and is a form of “radiofrequency ablation” that is not like the SDR procedure.2 Some patients may benefit solely from facet injection, which is a combination of an anesthetic and a corticosteroid. The corticosteroid is meant to reduce the inflammation and the anesthetic blocks the pain. The pain relief may last days or even years, allowing the patient to work on their exercises and physical therapy. Sometimes doctors use the facet injections for diagnostic purposes, to see if the “blocks” could demonstrate if a patient is a candidate for the ablation procedure. The patients most likely to benefit from facet injections are those with spinal stenosis, spondylolysis, sciatica, herniated disc, arthritis, and those with post-operative pain after having spinal decompression or discectomy surgery. The injections are contraindicated in pregnant patients and in those with bleeding problems or infection. Facet injections may also elevate the blood pressure or blood sugar, temporarily.3
There are different rhizotomy procedures, but they are not the same. The facet rhizotomy is an outpatient procedure that uses a “simple probe to apply radiofrequency waves” to the nerve root between the vertebral body and the facet joint. The RF lesioning “results in five to eight or more months of pain relief before the nerve regenerates”, after which time the procedure needs to be repeated. SDR (selective dorsal rhizotomy), dorsal rhizotomy, or SPR (selective posterior rhizotomy) is the “primary treatment for spastic diplegia” and is “best done in the youngest years”, but can be performed on adults. With this type of surgery, there is an incision made to the lower back, “just above the buttocks”. This permanent procedure “addresses the spasticity at its neuromuscular root”. After the surgery, since the spasticity of the muscles is eliminated, the true strength or weakness of the muscles becomes apparent. Interestingly, “the muscles may have been depending on the spasticity to function” and, post-surgically, the patient will experience a great deal of weakness and will have to strengthen the muscles with physical therapy. They will also have to relearn daily tasks and movements. Rhizotomy is typically done on pediatric patients, between the ages of two and six, prior to “orthopedic deformities from spasticity”. It had generally been believed that younger patients could more easily “re-learn how to walk” and would probably forget their former spasticity. However, recently successful SDR surgery over many age ranges has led to a counter-argument that it may be easier for older patients to relearn walking due to their maturity and awareness of what is happening, leading to more focus and harder work.4
After the facet rhizotomy, patients could have soreness, bruising, or swelling at the site of the injection, but most people can resume regular activities the next day. Alternative treatments and home care play a role in recovery. Patients may wish to use cold therapy or NSAIDs to manage the soreness. Complications are rare, but patients should contact a physician immediately if they have long-lasting pain at the site of the injection, chills, fever, weakness, dizziness, numbness lasting over three hours, or bleeding at the injection site.5 Physiotherapy may include strengthening muscles in the back and abdomen, and a therapist could give advice about ergonomics and posture.6 It is usually advised that patients wait a couple of days to do heavy lifting or physical activity, but “physical therapy and chiropractic care can be resumed immediately”.7 For back pain, injections, medication, and surgery are not necessarily the only answers. Massage, chiropractic, and acupuncture are some of the alternative treatment options. Through spinal manipulation, chiropractors can “relieve pressure on the spinal nerves, restore joint mobility, and help return the body to health”. Some chiropractic offices also offer massage and acupuncture, and they can provide lifestyle, exercise, nutritional, and ergonomic advice, as well. Some people feel that acupuncture helps promote healing and provides back pain relief, while others promote herbal medicine or even biofeedback as alternative treatment options.8