Sometimes we have pain that doesn't go away no matter what medicine we take or physical therapy we do. How difficult is it to live with this constant pain for months, maybe even years? Today we are going to talk about a special medical procedure used for chronic pain and conditions where muscles become stiff (spasticity) that are difficult to control with other treatments.
So, what is this rhizotomy?
Simply put, rhizotomy is a medical procedure that damages and impairs the function of specific nerve fibers that are causing chronic pain or muscle stiffness.
Think of our nervous system as a system of electrical wires. These wires carry messages from the brain to other parts of the body, and from those parts back to the brain. When we feel pain, the pain sends a signal to the brain from the location where it is felt, saying, "This is where it hurts." A rhizotomy involves finding the exact nerve that carries the pain signal, damaging it, and stopping the signal from going to the brain. It's like cutting a faulty electrical wire. This stops the pain.
Doctors use several methods to damage these nerves:
| Methodology | A simple explanation |
|---|---|
| Surgical excision | Cutting and removing the nerve in question through open surgery or using a small camera-equipped device, such as an endoscope, inserted through a small incision. |
| Using a chemical | Injecting a chemical such as glycerin or glycerol near a nerve with a needle, damaging that nerve. |
| Radiofrequency Ablation | High-frequency radio waves are sent through a special needle, and the heat generated 'burns' the nerve in question. This is what we often call 'nerve ablation'. |
You may also hear the term 'neurotomy'. That's another name used for these rhizotomies. All of these do the same thing, which is to stop the nerve that's causing the pain.
What conditions are treated with rhizotomy?
The most important thing to remember is that rhizotomy is not a first-line treatment. Doctors usually consider it as a last resort when simple treatments such as painkillers, physiotherapy, and nerve blocks have failed.
There are several main types of rhizotomy, each targeting different nerves in the body.
Trigeminal Ganglion Rhizotomy
This targets the trigeminal nerve cluster on either side of our face. It is used for severe, chronic pain in the face.
- Trigeminal Neuralgia: A severe, electric-shock-like pain on one side of the face.
- Cluster headaches that are not controlled by treatment.
- Atypical facial pain for which no cause can be found.
- Postherpetic neuralgia (facial nerve pain that occurs after chickenpox).
- Facial pain caused by cancer.
Facet Rhizotomy
This targets the nerve roots that pass through the facet joints between our vertebrae. This is often done for back pain and neck pain.
- If it is done on the neck, it is called a cervical rhizotomy .
- If it is done in the lower back, it is called a lumbar rhizotomy .
- This is an effective treatment for chronic pain caused by wear and tear in the joints of the spine due to diseases such as arthritis.
Selective Dorsal Rhizotomy (SDR)
This is specifically done to control spasticity in some children with cerebral palsy . This involves selectively damaging some of the sensory nerve fibers in the lower part of the spinal cord. However, not all children with cerebral palsy are suitable for this surgery. This is something that doctors decide.
How do you prepare for this treatment?
Because this is a surgical procedure, you will need to undergo several tests beforehand to make sure your body is suitable for it and that you will really benefit from it.
- Imaging tests: MRI scans and X-rays are used to carefully examine the affected nerve and the surrounding area.
- Nerve block: To determine exactly whether the problem is in this nerve, an injection is given that temporarily numbs the nerve. If this reduces the pain, the rhizotomy is more likely to be successful.
- Blood and urine tests: Check the overall health of the body.
If the surgery is being performed under general anesthesia, you will need to see an anesthesiologist. Also, if you are taking any medications, such as blood thinners, you will need to stop taking them a few days before the surgery. Never stop taking your medications without your doctor's advice. Your medical team will explain everything to you.
What happens during treatment?
This process varies depending on the type of rhizotomy, but in general, these are some of the steps that are followed:
1. Anesthesia: In most cases, you will be put completely to sleep (general anesthesia). In some simple procedures, you may be given a light sleep (sedation) or a local anesthetic (numbing only the area).
2. Imaging guidance: During the surgery, a technique called fluoroscopy, similar to X-rays, is used to ensure that the needle or instrument is positioned exactly near the correct nerve. Sometimes, a special liquid (contrast dye) may be injected into a vein to make the nerves more clearly visible.
3. Testing the nerve: Before damaging the nerve, a small electrical signal is given to the nerve to make sure it is the right nerve. This can be done using a test such as EMG (Electromyography).
4. Nerve damage: Finally, one of the three methods discussed earlier (cutting, chemicals, or radiofrequency heat) is used to stop the nerve that is causing the pain from functioning.
How successful is this? What are the risks?
Many people who undergo rhizotomy experience long-term pain relief . However, not everyone gets the same results. Some people may not experience any pain relief at all. You can talk to your doctor about how effective this will be for your condition.
Risks and complications vary depending on the type of rhizotomy performed.
- In general, it is normal to experience some pain, bruising, and bleeding at the site of the needle or surgical incision. This will go away in a few days.
- Very rarely, infection can occur in those areas.
- Some side effects are to be expected. For example, after a trigeminal rhizotomy for facial pain, you may lose feeling on that side of your face. Your doctor will discuss all of these with you before surgery.
When you need to see a doctor quickly
After treatment, if the surgical site becomes swollen, red, or pus-filled (signs of infection), or if you develop new nerve problems, such as numbness or tingling in one leg or arm, call your doctor immediately.
Take-Home Message
- Rhizotomy is a procedure that treats chronic pain and muscle stiffness by inactivating the nerves that carry pain signals.
- This is not the first treatment. It is an option to consider when things like medication and physical therapy don't work.
- Although this treatment has successfully brought pain relief to many people, not everyone gets the same results.
- As with any surgery, there are risks involved. Therefore, it is important to discuss the pros and cons of this procedure with your doctor before making a decision.
💬 අදහස් (0)
තවමත් කිසිදු අදහසක් පළ කර නොමැත. ඔබේ අදහස පළමු වරට මෙහි එක් කරන්න.
ඔබේ අදහස එක් කරන්න