Rhizotomy
A rhizotomy procedure helps treat painful nerve pain through a minimally invasive surgical procedure. This procedure removes the painful nerve sensation by killing the nerve fibers responsible for sending pain signals to your brain. A rhizotomy involves your surgeon severing the nerve fibers with a surgical instrument or burning them using a chemical or electrical current. Rhizotomies can provide immediate relief that lasts up to several years.
You may hear rhizotomy procedures referred to as ablation or neurotomy, which both simply refer to the removal or deadening of tissue.
At Pain Specialists of Charleston, we offer advanced technology to diagnose and treat the root cause of your chronic pain. The goal of our board-certified pain physicians and medical staff is to provide our patients with genuine relief. No referral needed!
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WHAT CAN IT TREAT
General Uses of Rhizotomy
- To treat chronic pain and spasticity caused by nerve damage/issues
- To help conditions that show no improvement with conservative treatments like physical therapy, NSAIDs, or nerve blocks
- To target specific nerves causing chronic pain
Specific Conditions Treated
- Back and Neck Issues:
- Arthritis
- Degenerative spinal conditions
- Disc herniations
- Facet joint pain in the neck or lower back
- Facet joint syndrome
- Neurological and Facial Pain:
- Trigeminal neuralgia (pain caused by facial nerve irritation
- Chronic cluster headaches that don’t respond to other treatment methods
- Atypical facial pain (persistent, unexplained pain in the face)
- Postherpetic neuralgia (facial nerve pain after having shingles)
- Cancer-related facial pain
- Spasticity Disorders:
- Cerebral palsy-related spasticity (involuntary muscle contractions)
Healthcare providers often recommend rhizotomy for patients whose pain has not improved with less invasive treatment options. Your doctor or pain management physician can help you determine if a rhizotomy procedure is right for you.
TYPES OF RHIZOTOMY
Trigeminal Ganglion Rhizotomy:
- Targets the trigeminal ganglia on each side of the face, the nerve clusters responsible for sending pain, touch, pressure, and other sensory information to your brain
- Often used to treat cluster headaches, facial pain, facial cancer-related pain, and trigeminal neuralgia, a chronic pain disorder affecting the trigeminal nerve in the face
- This procedure is often called percutaneous rhizotomy – percutaneous means “through the skin.”
Facet Rhizotomy:
- Targets nerves in the facet joints of the spine, from the neck to the lower back
- A cervical rhizotomy treats chronic pain caused by facet joints in the neck and a lumbar rhizotomy treats chronic pain caused by facet joints in the lower back
- May be recommended for patients suffering from osteoarthritis, spinal stenosis, spondylolisthesis, or other spinal conditions
Selective Dorsal Rhizotomy:
- Primarily focuses on specific sensory nerve fibers in the lower spinal cord
- Reduces spasticity in children who have cerebral palsy and improves mobility and function
- A specialist will determine a child’s eligibility as not all children with cerebral palsy are candidates
RISK FACTORS
Common Side Effects
- After the procedure, you may feel some mild discomfort including:
- Soreness at the injection/incision site
- Bruising around the treated area
- Minor bleeding at the injection/incision site
- The effects of the procedure are temporary and typically resolve themselves within a few days
Rare Risks and Complications
- In rare cases, patients may develop an infection at the injection/incision site
- Some procedures, such as trigeminal rhizotomy, may cause loss of sensation in certain areas (facial numbness, for example)
What to Expect
- Certain effects are considered normal and not a complication, depending on the rhizotomy performed.
- Your healthcare provider will explain potential risks and complications prior to your rhizotomy procedure
WHAT TO EXPECT DURING THE PROCEDURE
BEFORE THE PROCEDURE
Your procedure preparation process will depend on the type of rhizotomy you’re undergoing, as each procedure has its own process. Your healthcare team will give you instructions before the procedure, so you know exactly what you need to do. If you have questions or concerns, don’t hesitate to ask.
To make sure the rhizotomy is the best option for you, your healthcare team will most likely recommend various tests beforehand. These tests may include:
- Imaging tests, such as an MRI or X-rays
- Nerve block to detect problematic nerves
- Blood tests
- Urinalysis
If your rhizotomy procedure is going to require general anesthesia, your doctor may have you schedule an appointment with the anesthesiologist before the procedure to ensure it is safe. Your anesthesiologist may perform tests to check your heart’s health.
Your doctor may also require you to stop taking certain medications, like blood thinners, to ensure the safety of the procedure. Your physician will let you know if this applies, so do not stop taking any medications unless you are instructed to do so.
DURING THE PROCEDURE
Preparation and Anesthesia
- Preparation will be determined based on the type of rhizotomy being performed and the nerves targeted. Your doctor will provide specific instructions.
- Anesthesia options include:
- General Anesthesia: Fully asleep and won’t feel pain
- Sedation: You’ll feel calm and relaxed
- Local Anesthesia: Only numbs the specific area being treated
Locating the Nerves
- To find the problematic nerves, providers use imaging tools, like a live X-ray (fluoroscopy)
- A contrast dye may be used to make nerves more visible for imaging. The dye is injected through an IV
Testing the Nerves
- Your provider will test the suspected nerve causing pain with electrical stimulation to confirm the issue
- Testing may involve:
- Stimulating the nerve by inserting a microelectrode through a hollow needle
- Monitoring nerve response by using electromyography (EMG)
Destroying the Nerves
- Your provider will destroy the targeted nerve using one of the following methods:
- Chemical Ablation: Injecting chemicals through a needle to deactivate the problem nerve
- Radiofrequency Ablation: Delivering heat through a needle to destroy the nerve
- Surgical Cutting: Removing or severing the nerve through:
- Open Surgery: Requires a larger incision
- Endoscopic Surgery: Small incision to insert a tiny camera for precision
AFTER THE PROCEDURE
Returning to Activities
- Resume work and regular activities the following day
- Avoid strenuous activities and heavy lifting for one to two days
- Showering is allowed, but for the next 24 hours avoid:
- Bathing
- Swimming
- Soaking in a hot tub
Managing Side Effects
- You may feel:
- Mild discomfort
- Soreness or bruising
- Swelling at the procedure site
- Tenderness or tingling near the procedure site
- These symptoms may last approximately a few days to a couple of weeks
- An ice pack and over-the-counter pain relievers can provide relief
Pain Relief and Recovery
- Expect gradual improvement in pain levels following the procedure
- Full recovery and maximum pain relief can take approximately two to four weeks
Long-Term Results
- A successful rhizotomy procedure stops the targeted nerves from causing further pain
- Pain relief can typically last six months to two years until the nerves grow back
- Procedure can be repeated if needed to extend relief
WHEN SHOULD I SEE A PAIN PHYSICIAN
If you’re dealing with chronic nerve pain that does not see improvement with more conservative pain management techniques, talk to a pain management physician near you to see if a rhizotomy is an option for you.
If you’ve had a rhizotomy procedure, talk to your pain physician if you notice any post-procedure complications, such as an infection at the incision site or signs of nerve issues like burning pain or weakness.
To learn more about rhizotomy procedures, contact Pain Specialists of Charleston today. Our board-certified pain physicians are here to help you find relief and take back your quality of life.
CONDITIONS WE MANAGE
- KNEE PAIN
- CHEST PAIN
- SHOULDER PAIN
- BACK PAIN
- HIP PAIN
- NECK PAIN
- ELBOW PAIN
- FOOT PAIN
- WRIST PAIN
- & MORE!
TREATMENT WE OFFER
At Pain Specialists of Charleston, our board-certified team offers pain management treatment in the form of:
- Epidural Steroid Injection including cervical, thoracic, and lumbar injections
- Joint injections including knee, shoulder, and hip injections
- Caudal Epidural Injection
- Hip Joint Injection
- Lumbar Sympathetic Block
- Facet Joint Injection
- Medial Branch Block
- Radiofrequency Ablation (Rhizotomy)
- Sacroiliac Joint Injection
- Discography
- Neurostimulation, also known as Spinal Cord Stimulation
- Stellate Ganglion Block
- Transforaminal Selective Nerve Root Block Injection
- Medical Massage Therapy
- Clinical Trials
- …and MORE!
ABOUT PAIN SPECIALISTS OF CHARLESTON
At Pain Specialists of Charleston, our mission is to provide you with relief from your chronic pain through the latest, most innovative pain management treatments available. Whether you’re suffering from back pain, whiplash, or anything in between, we can help you get back to feeling like yourself once again.
Plus, no referral is necessary!
At our pain management clinic, our experienced team approaches your pain through a variety of services to best meet your needs. This includes anesthesiology, neurology, psychology, and nursing. Our providers believe in collaborating with your healthcare team – your primary care physician, specialists, chiropractor, physical therapist, and especially you, the patient, to bring you the care you need.
Our private practice is powered by a talented, carefully selected leadership team.
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MEET DOCTOR EDWARD M. TAVEL, JR., MD
- Over 30+ Years of Specialty Training
- Double-Board Certified in Anesthesiology and Pain Management
AWARDS & ASSOCIATIONS
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FAQs
What is the success rate of a rhizotomy?
Like most procedures, doctors can’t guarantee a 100% effectiveness rate with a rhizotomy procedure. A vast majority of people who undergo a rhizotomy experience long-lasting pain relief or see significant improvement in their spasticity. However, a portion of patients experience little to no relief. Even though a large percentage of rhizotomies are successful, your doctor will provide more in-depth information about success rates for your specific procedure.
When you visit our pain management clinic, we will begin with a comprehensive 30-minute exam to understand your condition and narrow down the best pain treatment to find relief. Schedule an appointment today! No referral needed!
What should you not do after a rhizotomy?
For best results, you should avoid doing the following things after your rhizotomy procedure:
• Do not drive for at least six hours or while on pain medications
• Do not bathe, swim, or soak in a hot tub for at least 24 hours after the procedure to reduce the risk of infection
You are able to shower four hours after your procedure but no sooner. Overall, please work with your physician directly to determine which daily activities are safe to participate in following your rhizotomy procedure.
What are some relief options after a rhizotomy?
Your doctor may recommend a variety of relief options after the initial procedure, such as:
- Taking your usual medications
- Removing the bandages after four hours
- Applying ice to the injection area in 20-minute intervals five to six times per day, if there is injection-site pain
Please speak with your physician directly about the best relief methods to follow while recovering from a rhizotomy procedure.
What are some possible complications after a rhizotomy?
Some complications to be on the lookout for include:
- Numbness, weakness, and tingling in the arms or legs lasting for more than eight hours
- Temperature higher than 101 F˚
- Nausea, headache, or stiff neck
- Difficulty urinating or inability to urinate
- Excessive bleeding or drainage from the injection site
- Unusual swelling or redness at the injection site
- Difficulty breathing or chest pain with breathing
If you experience any of the above complications, call your doctor’s office. If it’s after hours, visit the nearest emergency room.
What are the benefits of a rhizotomy procedure?
Rhizotomy procedures are designed to remedy chronic nerve pain in the back and neck that is becoming debilitating in a person’s life. The procedure is effective, minimally invasive, and safe, and it helps patients reduce pain, restore movement, and return to their daily activities. A rhizotomy can provide much-needed relief for significant nerve pain.
Patients often benefit from a rhizotomy when their nerve pain is limited to a single spot or region in the spine and aren’t experiencing additional symptoms. If you’re in the Charleston area and in need of pain relief, reach out to us directly for appointments! No referral necessary!
What does a rhizotomy treat best?
Rhizotomy procedures are most often used to treat a wide range of nerve issues in the neck and back, such as:
- Arthritis
- Degenerative spinal conditions
- Disc herniations
- Joint pain
- Spasticity and pain caused by cerebral palsy
- Trigeminal neuralgia (facial pain caused by trigeminal nerve irritation)
How long is recovery after a rhizotomy procedure?
Following a rhizotomy procedure, patients are typically back on their feet quickly, but this can depend on response to anesthesia. Many people are able to get back to regular activities, including driving and going to work, as soon as one or two days. With that being said, some people experience pain, swelling, or bruising at the injection site which may impact your full recovery time. Talk to your doctor about recovery time after your rhizotomy procedure when you visit our pain clinic.
What if rhizotomy doesn’t work?
Like most procedures, a rhizotomy doesn’t have a 100% effectiveness rate for all patients who undergo the procedure. A vast majority of patients experience desired pain relief following the procedure. A small percentage of patients may feel no significant relief. It’s best to talk with your doctor about the next steps if a rhizotomy doesn’t work and determine whether a second rhizotomy, another type of rhizotomy, or another treatment option is the best course of action for you.
What are the different types of rhizotomy procedures?
There are different types of rhizotomy, which all involve destroying nerve fibers that are carrying pain signals to your brain. Depending on the location of the nerve, rhizotomies may be performed under general or local anesthesia. In addition, they often use X-ray, fluoroscopy, or other image-guided techniques to ensure precision.
- Glycerin/Glycerol Rhizotomy: This rhizotomy involves the use of a needle to deliver a small amount of a chemical (glycerin or glycerol) to the root of the affected nerve. This chemical destroys the nerve’s pain fibers over the course of 45 to 60 minutes.
- Radiofrequency Rhizotomy: Radiofrequency rhizotomy (also known as radiofrequency ablation) uses a radiofrequency current to burn the nerve fibers. It is often used for patients who do not experience complete relief from glycerin or who have recurring pain and may need additional assistance to get through scar tissue.
- Endoscopic Rhizotomy: This type of rhizotomy involves the use of a camera called an endoscope to locate the affected nerve and sever its fibers. The endoscope is inserted through a small incision using a series of tubes known as a tubular retractor system. This method allows the surgeon to reach the nerve and bypass healthy organs and tissues. This procedure is also known as direct visualized rhizotomy.
What is a rhizotomy?
A rhizotomy is a procedure that targets painful nerves in the facet joints of the spine. Each vertebral segment in your spine contains facet joints which each contain a medial nerve. These nerves provide sensation to the joint but can also cause significant pain when inflamed or irritated. The main goal of rhizotomy is to eliminate the irritated nerve at a specific location to stop it from sending pain signals from the facet joint to the brain.
When to see a doctor for a rhizotomy?
If you’re dealing with chronic lower back pain, neck pain, or arthritis, talk to your primary care doctor or a pain management doctor about a rhizotomy as an option for your pain relief.
Pain Specialists of Charleston offers a team of board-certified pain management physicians to diagnose and treat your pain. For your first visit, we will conduct a comprehensive 30-minute exam to address your symptoms, and your current state of health, and narrow down the best pain treatment to find relief. Schedule an appointment today! No referral needed!