Rhizotomy procedures are minimally invasive treatments used to treat facet joint pain. Facet joints are where the bones of the spine (vertebrae) meet and they allow your back to be flexible and enable you to bend and twist. Nerves exit the spinal cord through the facet joints to serve the rest of the body. When injury or age causes the cartilage of facet joints to deteriorate, the nerves can become compressed and the vertebrae can start to grind on one another. This causes pain. A rhizotomy procedure works by disrupting a nerve’s ability to transmit pain signals to the brain. The pain relief from a rhizotomy can last up to a year, sometimes longer. Facet joint rhizotomies are also known as radiofrequency rhizotomy.
Candidates for rhizotomy procedures have typically first undergone several facet joint injections to verify the source and exact location of their pain. If the facet joints were successful but just not providing relief for long enough, a rhizotomy procedure could be required. Conditions that are treated by rhizotomies include spondylosis (spinal osteoarthritis), degenerative disc disease, and spinal stenosis. For decades, the main use of rhizotomy was for spastic cerebral palsy with a treatment known as selective dorsal rhizotomy (SDR). Spasticity in cerebral palsy patients causes extreme pain and deformity, but through the use of selective dorsal rhizotomy, spasticity-causing nerves can be isolated and then targeted and destroyed.
Rhizotomies are often done as an outpatient procedure, meaning an overnight stay is rarely necessary. They can be done while the patient is awake or under conscious sedation. The skin around the area to be injected is cleaned and a local anesthetic is injected to numb the area. Fluoroscopy is then positioned to allow the physician to view the spinal level during the procedure. After a small amount of contrast (dye) is injected to confirm placement a controlled, mild electrical current is sent through the electrode and the nerve’s ability to transmit pain signals is blocked. Most rhizotomy procedures take about 15-20 minutes but may take longer if more than one spinal level is treated.