What is a Rhizotomy Procedure?
During a rhizomtomy neurosurgical procedure, problematic spinal nerve roots are selectively severed to correct symptoms associated with neurological conditions. In problematic pinched nerve situations where conservative measures have had little to no effect on the symptoms, a rhizotomy procedure may be considered as a corrective measure.
The Rhizotomy Procedure
A 1 – 2 inch is made along the center of the lower back to begin the rhizotomy procedure. The surgeon will then perform a laminectomy to gain access to the spinal cord and spinal nerve. When the laminectomy is performed a portion of the lamina is removed which exposes the target nerves. The surgical team utilizes ultrasound and x-ray technology to locate the tip of the spinal cord to find the natural separation of the sensory and motor nerves. A special rubber pad is then placed to provide a division between these two nerve sets. The sensory nerve roots are tested and selectively eliminated; they are placed on top of the pad while the motor nerves will remain beneath the pad for their protection.
Once the sensory nerves have been exposed they are divided into 3 – 5 rootlets. These rootlets are then tested with specialized equipment recording the electrical patterns in the muscles. The severity of the damage is rated from 1 to 4, with the later being the most severe. Rootlets that are severely abnormal are cut and the procedure is repeated between spinal nerves L2 and S2.
When testing and severing of the damaged nerves is complete, the dura mater if closed; sensory nerves are then directly bathed with fentanyl. Other layers of tissue, muscle, subcutaneous, and fascia are then sewn back together. Depending on the surgeon’s preference, the wound will be closed with either stitches or surgical glue.
The duration of the surgery is approximately 4 hours and will typically require one neurosurgeon, one anesthesiologist, and a team of assisting physicians. Recovery from a traditional rhizotomy procedure will take 1 – 2 hours and then the patient is transferred to the ICU for an overnight stay. The patient is then transferred from the ICU to a recovery room where they will be monitored for 3 days. Prior to surgery the patient will have their range of motion tested and recorded. For the 3 days following the surgery, new range of motion tests will be performed and compared to the tests prior to the surgery.
Minimally invasive laser assisted rhizotomy procedures are available, which will speed up the process and cause less damage to the tissue and muscles. Before surgery is attempted it is important to weigh the pros and cons and make sure you have exhausted all your other options.