Rhizotomy: Definition and procedure (is there any danger?)

rhizolysis

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

La rhizotomy is a technique medicale which focuses on pain relief related to a disorder in the posterior lumbar or cervical joints. It is intended for people who wish to avoid surgery.

In this article, we will explain what the rhizotomy is, see how it takes place, how much the procedure costs, and what the possible complications are.

Definition of rhizotomy

To better understand rhizotomy, it is worth briefly explaining the anatomy of the spine, and vertebrae that compose it.

Anatomy

La spine consists of the juxtaposition of bones called vertebrae. Also called rachis, it is separated as follows:

  • 7 cervical vertebrae
  • 12 thoracic (or dorsal) vertebrae
  • 5 lumbar vertebrae
  • 5 sacral vertebrae (forming the sacrum)
  • 4 coccygeal vertebrae (fused)

Here is a visual diagram of the spine:

In general, each vertebrate is composed of a vertebral body in its front part, and of a posterior arc (posterior articulations) at the back formed by the pedicles and the spinal blades.

Irritation of the posterior joints

Due to the constraints on the spine, it can appear over time a wear of the posterior joints. This condition refers to facet osteoarthritis.

In facet osteoarthritis, we observe a destruction of the articular cartilage which thins, cracks and eventually disappears. Once the cartilage is destroyed, all other joint structures can be affected, including nearby nerves. These lesions will then be responsible for pain in the spine.

Rhizotomy

La rhizotomy is heat treatment spinal pain using heated electrodes. It acts on pain caused by back pain, especially in the posterior joints allowing mobility and stability of the spine. Essentially, the purpose of the rhizotomy is to destroy part of the emerging nerves in the spine so that you no longer feel pain.

More specifically, this intervention allows the destruction of the posterior (and median) nerve branch of the vertebral column innervating the posterior joints. By cutting off the afferent nerve signal to the brain, the pain message is somehow blocked, which allows the relief of symptoms.

Rhizotomy is also called radiofrequency denervation, radiofrequency ablation, lumbar radiofrequency, lumbar thermocoagulation, posterior joint thermocoagulation, and radiofrequency neurotomy.

Indications for rhizotomy

La rhizotomy is indicated mainly in case of chronic lower back pain. It relieves pain when it comes from the posterior joints.

Indeed, the indication must be strictly posed in a patient whose vertebral pain comes from a facet osteoarthritis (also called zygapophyseal osteoarthritis). Sometimes the use of a diagnostic infiltration under radiological guidance will confirm the diagnosis, and allow the realization of a rhizotomy.

It should be noted that the rhizotomy does not cure the cause of the pain. It corresponds rather to an analgesic treatment which acts on the painful symptoms of the pathology in question. 

If the rhizotomy has already given positive results, it can be repeated after a few months or years if necessary. Otherwise, consider other surgical techniques appropriate to your situation (prosthesis, arthrodesis, etc.).

Which specialist to consult?

Rhizotomy is performed in an operating theater or on an outpatient basis by an orthopedic surgeon and traumatologist, a vertebra specialist. He is able to make the diagnosis and proposes the necessary treatments.

How is the intervention carried out?

The rhizotomy is performed percutaneously, without incision. It leaves no scars on the skin. It is also a painless procedure that lasts between 10 to 20 minutes. The temperature used during rhizotomy is 80°C.

Before the procedure, the doctor applies local anesthesia to the area to be treated. The patient is also put under general anesthesia with a light dose of sedative.

The intervention itself

On an operating table, the patient will lie down on his stomach with optimal aseptic conditions. Then, the doctor performs an x-ray scan on the painful parts to better observe the area where the nerves pass.

Once this step is completed, he places needles (single-use) on the parts of the posterior joints. In each needle are placed heating electrodes. The latter, in contact with the facet joints, will destroy part of the spinal nerves responsible for transmitting pain sensations in this area.

The action of the electrodes on the nerves will thus allow the decreased conduction of pain signals to the brain.

The operation is under permanent radiological monitoring to avoid injury to other nerves located in the area of ​​operation (such as the nerve sciatica ou cruel).

How much does a rhizotomy cost?

For a rhizotomy, you should allow 200 to 300 euros per intervention. These fees will be invoiced and may sometimes be reimbursed by your company according to your employment contract.

Recovery and complications after a rhizotomy?

After the procedure, you will be taken to a room while you wait for your release. The outpatient stay lasts about 3 to 5 hours so that you can regain your autonomy. Of course, the doctors always recommend that you be accompanied on the day of the operation. This is essential for your safety. Likewise, it is strictly forbidden to drive when leaving the hospital.

Compared to other types of intervention, the recovery time after rhizotomy is relatively fast. Most patients who underwent it recovered their full strength after only 48 hours, without rehabilitation.

Work stopping ?

Stopping work is not mandatory after the rhizotomy. It depends above all on the physical condition of each patient, and the physical nature of his work. As some people are likely to recover faster than others, the doctor will make decisions on a case-by-case basis.

How long before work?

Return to work may be immediate depending on the patient's condition, but the adequate recovery time after rhizotomy is usually 48 hours. After this period, you can walk and resume your daily activities.

There is no specific rehabilitation after rhizotomy. On the other hand, you must do an active rehabilitation. This must follow the programs that have been prescribed by your surgeon.

You can wear a lumbar support belt during the first week after the intervention. It is sometimes recommended by a specialist.

Side effects of a rhizotomy?

Within the framework of the rhizotomy, side effects are rare. Your surgeon will explain them to you in detail during your consultation. It is from the complete study of your medical file as well as the results of your examinations that this one will be able to give you the best solution vis-a-vis these complications.

The risks are generally limited to poor positioning of the needle, the appearance of hematoma or an allergy.

The generic risks are the ones most often encountered during a rhizotomy intervention. They can be linked to allergies, heart failure, lung infections…

The risks typical of this type of intervention, on the other hand, are very rare. They include: the sensations of tingling in the leg which are due to the heating of the nerves which are there, infections, the development of a hematoma...

And for the consequences?

Like all types of surgery, rhizotomy can present risks of complications. Some disorders may occur during or after the procedure.

  • Le risk of blood flow (hematoma) : it is also very rare, because the rhizotomy is just a simple puncture. If you are taking blood thinners, you should suspend them for a few hours before the procedure, as they can cause other side effects other than hematoma.
  • Le risk of infection is quite low, because the heated electrodes (80°C) allow disinfection of the intervention site.

Here are some risk factors that can favor the appearance of these complications:

  • alcoholism;
  • smoking;
  • substance addiction ;
  • psychiatric conditions;
  • diabetes,
  • hepatitis…

Pain after rhizotomy?

After rhizotomy, you may feel lower back pain, but of low intensity, quite bearable. These pains will be soothed with analgesics if necessary. Painkillers are systematically taken after the operation.

Conclusion

To conclude, the rhizotomy has been used for the management of lower back pain for twenty years. It could be the solution to relieve your back pain, and this, to escape more invasive surgery. Its effectiveness has been proven in many subjects over a period of 5 years.

If you wish to benefit from this type of treatment, consult directly a surgeon specialized in the field. He is the only one authorized to give you accurate and concrete information. Moreover, insofar as you are on your second treatment, you must be vigilant about the symptoms that appear after the operation.

If the pain persists or the duration of its effect shortens, notify your doctor as soon as possible.

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