I’ve had off-and-on back pain issues all my life since high school! That led me to eventually get into therapeutic bodywork. Looks like I’ll be getting a rhizotomy sometime soon so I wanted to do some research and this is what I found.
What is rhizotomy?
Rhizotomy is a minimally invasive surgical procedure to remove sensation from a painful nerve by killing nerve fibers responsible for sending pain signals to the brain. The nerve fibers can be destroyed by severing them with a surgical instrument or burning them with a chemical or electrical current. In most cases, rhizotomy provides immediate pain relief that can last up to several years until the nerve recovers and is able to transmit pain again.
Rhizotomy can also be called ablation or neurotomy — all of these terms describe the removal or deadening of tissue.
What conditions can be treated with rhizotomy?
Rhizotomy can be used to address different types of pain and abnormal nerve activity, such as:
- Back and neck pain from arthritis, herniated discs, spinal stenosis, and other degenerative spine conditions. The procedure for these issues is called facet rhizotomy, as it involves the nerves traveling through the facet joints of the spine.
- Trigeminal neuralgia — facial pain due to the irritation of the trigeminal nerve.
- Pain in joints, such as the hip and knee, resulting from arthritis.
- Other conditions affect the peripheral nerves.
- Spasticity (abnormal muscle tightness and spasms). For spasticity caused by cerebral palsy, a procedure called selective dorsal rhizotomy can help improve communication between the spine and muscles.
Types of Rhizotomy
There are several types of rhizotomy, all of which involve destroying the fibers within a nerve that carry pain signals. Depending on the location of the nerve, rhizotomies can be performed under general or local anesthesia and often use X-ray, fluoroscopy, or another image-guided technique to ensure precision.
With this type of rhizotomy, a surgeon uses a needle to deliver a small amount of a chemical (glycerin or glycerol) to the root of the affected nerve. The chemical destroys the pain fibers in the nerve over the course of 45 to 60 minutes.
Radiofrequency rhizotomy (also known as radiofrequency ablation) is similar to glycerin rhizotomy, but instead of using a chemical to destroy the nerve fibers, a radiofrequency current is used to burn the fibers. It is often used for patients who do not get complete relief from glycerin or those who have recurrent pain and may need assistance to get through scar tissue.
With endoscopic rhizotomy, a surgeon uses a camera device called an endoscope to locate the affected nerve and sever its fibers. The endoscope is inserted through a small incision via a series of tubes called a tubular retractor system. This allows the surgeon to get to the nerve while bypassing healthy organs and tissues. This procedure is also called direct visualized rhizotomy.
Recovery After a Rhizotomy
The rhizotomy itself takes only a few minutes. Afterward, you will spend several hours in the recovery room. Depending on how you handle the anesthesia, you may be able to return to work one or two days after the procedure.
It is common to experience pain, swelling, and/or bruising at the surgical site.
Risks and Side Effects of Rhizotomy
The risks associated with rhizotomy depend on the type of procedure and which nerves it’s performed on.
- Glycerin/glycerol rhizotomy risks include bleeding, infection, nausea, vomiting, a small chance of sensory change (feeling of numbness), and anesthesia complications.
- Radiofrequency rhizotomy has a higher likelihood of causing sensory change (feelings of numbness) than the chemical method.
What if rhizotomy doesn’t work?
Like most procedures, rhizotomy doesn’t offer a 100% success rate for 100% of patients who undergo it. A small percentage of people may feel no significant pain relief after rhizotomy. Those who do get the desired pain relief may experience the pain gradually returning after several years as the nerve regrows.
It’s best to consult with your doctor to determine whether a second rhizotomy, another type of rhizotomy, or another treatment will offer the most pain relief if the pain comes back. Depending on the origin of your pain, other treatment options could include decompression surgery to remove or move aside tissues pressing on the nerve.
Is a rhizotomy the same as a nerve block?
Can I walk after a rhizotomy?
How do you prepare for a rhizotomy?
Your doctor reviews all the medications, vitamins, and herbal supplements you take. Certain drugs (e.g., blood thinners), such as NSAIDs (non-steroidal anti-inflammatory drugs) and supplements should be stopped several days before your procedure.
See my other posts on back pain here:
Back pain is a common ailment that can significantly affect a person’s quality of life. It can arise from various sources and has a complex underlying science. One potential treatment for chronic back pain, particularly when it is related to facet joint problems, is a procedure called rhizotomy or facet rhizotomy. To understand the science behind back pain and the benefits of getting a rhizotomy for relief, let’s break down these concepts.
Science of Back Pain: Back pain can originate from various structures in the spine, including muscles, ligaments, discs, and facet joints. The facet joints are small, paired joints located between the vertebrae, and they play a role in stabilizing the spine and controlling its movement.
Facet Joint Pain: When the facet joints become irritated or damaged due to conditions like arthritis, injury, or degeneration, they can cause chronic back pain. The pain typically arises from inflammation, mechanical stress, or nerve irritation within or near the facet joints.
2. Nerve Involvement: In some cases, facet joint pain can involve irritation or compression of spinal nerves, leading to radiating pain, tingling, or numbness in the limbs. This is known as radiculopathy.
Benefits of Rhizotomy for Relief: A rhizotomy is a minimally invasive procedure aimed at relieving chronic back pain, specifically pain related to facet joint dysfunction. It involves the selective destruction or interruption of nerves that transmit pain signals from the facet joints to the brain. Here are the potential benefits of getting a rhizotomy:
Pain Relief: The primary benefit is pain relief. By disrupting the pain signals from the affected facet joints, a rhizotomy can provide significant relief for patients with chronic back pain. This can improve their overall quality of life and functionality.
Improved Mobility: Reduced pain often leads to improved mobility and physical activity. Patients may find it easier to engage in exercises and rehabilitation programs to strengthen their back muscles and improve posture.
Avoiding Surgery: Rhizotomy is a less invasive alternative to surgical interventions like spinal fusion or joint replacement. It can be particularly beneficial for those who want to avoid or delay surgery.
Short Recovery Time: Rhizotomy procedures typically have a shorter recovery time compared to major surgeries. Patients can usually resume normal activities within a few days to a week.
Minimal Side Effects: The procedure is generally safe, with minimal side effects. Some temporary numbness or discomfort at the injection site is common, but these usually resolve quickly.
It’s important to note that while rhizotomy can provide relief for facet joint-related back pain, it may not be suitable for all individuals or all types of back pain. A thorough evaluation by a healthcare provider is necessary to determine if a rhizotomy is the right treatment option, and it should be considered as part of a broader pain management plan, which may include physical therapy, medication, and lifestyle modifications.
In summary, the science of back pain involves complex interactions within the spine, and a rhizotomy can offer relief for chronic back pain caused by facet joint dysfunction. However, the decision to undergo a rhizotomy should be made in consultation with a healthcare professional after a thorough evaluation of the individual’s condition and treatment options.
The success rate of rhizotomy procedures in providing relief from back pain can vary depending on several factors, including the cause of the pain, the patient’s individual circumstances, and the specific technique used in the rhizotomy. It’s essential to recognize that rhizotomy is not a one-size-fits-all solution, and its effectiveness can differ from person to person.
That being said, studies and clinical reports suggest that rhizotomy can provide significant pain relief for a substantial percentage of patients with facet joint-related back pain. Success rates can range from 50% to 90% or more, depending on the study and the criteria used to define “success.”
Here are some factors that can influence the success rate of rhizotomy for back pain relief:
Patient Selection: Patients who are carefully selected based on their specific diagnosis, imaging studies, and response to diagnostic nerve blocks may have better outcomes.
Technique: The specific technique used in the rhizotomy procedure, such as radiofrequency ablation or cryoablation, can affect the success rate. Some techniques may have a higher success rate in certain patients.
Underlying Cause: The cause of back pain varies among individuals. Rhizotomy is most effective for pain caused by facet joint problems. It may be less effective for other sources of back pain, such as disc herniations or spinal stenosis.
Post-Procedure Care: Proper post-procedure care, including physical therapy and lifestyle modifications, can impact the long-term success of rhizotomy.
Individual Variability: Each patient’s response to the procedure is unique, and factors like pain tolerance, overall health, and the presence of other medical conditions can influence the outcome.
To determine the likelihood of success with a rhizotomy, individuals should undergo a thorough evaluation by a pain management specialist or interventional pain physician. They will consider the patient’s medical history, imaging results, and response to diagnostic nerve blocks before recommending the procedure. Additionally, patients should have realistic expectations about the potential outcomes, as complete and permanent pain relief is not guaranteed.
It’s important to discuss the expected benefits, risks, and potential complications of a rhizotomy with a healthcare provider to make an informed decision about whether the procedure is appropriate for a specific case of back pain.
Inflammatory back pain (IBP) is a type of chronic back pain characterized by inflammation of the spinal joints and surrounding tissues. It is typically associated with inflammatory conditions such as ankylosing spondylitis (AS), axial spondyloarthritis (AxSpA), and other related autoimmune diseases. Understanding the science and research behind IBP is crucial for the diagnosis, treatment, and management of this condition.
Science of Inflammatory Back Pain:
Underlying Inflammation: IBP is driven by inflammation, which can occur in the sacroiliac joints (located at the base of the spine), the vertebral column, and other spinal structures. The exact cause of this inflammation is often related to an overactive immune response.
Pain Characteristics: Unlike mechanical back pain, which is often related to physical stress or injury, IBP typically exhibits distinct characteristics:
- Morning Stiffness: Patients often experience prolonged stiffness in the morning, lasting at least 30 minutes to several hours.
- Improvement with Exercise: Physical activity and exercise can help alleviate the pain, in contrast to mechanical back pain, which may worsen with movement.
- Nocturnal Pain: Pain may interfere with sleep, particularly in the second half of the night.
Spinal Involvement: Inflammatory back pain often involves the entire spine and may lead to structural changes over time. In severe cases, it can result in ankylosis (fusion) of the spinal vertebrae.
Research on Inflammatory Back Pain:
Diagnostic Criteria: One of the key areas of research in IBP has been the development and refinement of diagnostic criteria. The Assessment of SpondyloArthritis International Society (ASAS) has established criteria to help healthcare providers identify IBP and axial spondyloarthritis, which can lead to more accurate and timely diagnosis.
Genetic Factors: Research has identified genetic factors associated with IBP and related conditions. The HLA-B27 gene, for example, is strongly linked to ankylosing spondylitis. These genetic markers can help in diagnosing and predicting the progression of the disease.
Treatment Advances: Ongoing research has led to the development of new treatments for IBP and related diseases. Biologic medications, such as TNF-alpha inhibitors, have been found to be effective in reducing inflammation and relieving symptoms in many patients.
Monitoring Disease Progression: Researchers have been studying methods to monitor disease progression, including the use of imaging techniques like MRI to detect inflammation and structural changes in the spine.
Patient-Reported Outcomes: Studies have focused on understanding the impact of IBP on patients’ quality of life and overall well-being. Patient-reported outcome measures help in assessing the effectiveness of treatments and interventions.
Prevention of Structural Damage: Research has aimed to identify strategies for preventing or minimizing structural damage to the spine in individuals with IBP, with a focus on early intervention and aggressive management.
Comorbidities: There is ongoing research into the association between IBP and other health conditions, such as cardiovascular disease, as well as the management of these comorbidities.
Inflammatory back pain is a complex and multifaceted condition, and ongoing research is critical for improving the understanding of its underlying mechanisms, early detection, treatment options, and long-term management. Early diagnosis and appropriate treatment can help alleviate symptoms, prevent or slow structural damage, and improve the quality of life for individuals living with IBP and related inflammatory conditions. Patients with symptoms of IBP should seek evaluation by a rheumatologist or a healthcare provider experienced in diagnosing and managing these conditions.
Mechanical back pain, also known as nonspecific low back pain, is a common musculoskeletal condition characterized by pain and discomfort in the lower back that arises primarily from mechanical factors such as strain, overuse, or poor posture. While it lacks the specific inflammatory or structural features seen in conditions like inflammatory back pain or herniated discs, it is a prevalent and significant health issue. Research into the science of mechanical back pain aims to understand its causes, risk factors, diagnosis, and management.
Science of Mechanical Back Pain:
Musculoskeletal Factors: Mechanical back pain often originates from musculoskeletal structures in the lower back, including muscles, ligaments, tendons, and intervertebral discs. These structures can be strained or injured due to various factors, such as improper lifting, sudden movements, or prolonged sitting.
Biomechanical Stress: Poor posture, improper body mechanics, and repetitive movements can place excessive stress on the spine, leading to mechanical back pain. This stress can result in muscle imbalances, microtrauma, or the development of trigger points.
Psychosocial Factors: Psychological factors, such as stress, anxiety, and depression, can influence the perception and persistence of mechanical back pain. Chronic pain can, in turn, contribute to psychological distress, creating a complex interplay between physical and emotional factors.
Neurological Factors: Although mechanical back pain is primarily a musculoskeletal issue, it can involve altered pain processing and sensitization of nerves in the affected area, which can contribute to the perception of pain.
Research on Mechanical Back Pain:
Causes and Risk Factors: Research into mechanical back pain aims to identify the various causes and risk factors associated with this condition. This includes understanding how activities like heavy lifting, poor ergonomics, and sedentary behavior can contribute to back pain.
Diagnostic Tools: Developing effective diagnostic tools and criteria is crucial for accurately diagnosing mechanical back pain. Researchers work on improving the accuracy of diagnostic methods, including physical examinations, imaging (such as X-rays or MRIs), and clinical assessments.
Treatment Modalities: Investigating the efficacy of various treatment modalities is a significant focus of research. This includes exploring the benefits of physical therapy, exercise programs, manual therapies (e.g., chiropractic or osteopathic care), pain medications, and minimally invasive interventions.
Prevention: Research aims to identify strategies to prevent mechanical back pain, particularly in occupational settings. This includes ergonomics and workplace interventions to reduce the risk of work-related back injuries.
Psychosocial Factors: Researchers also study the role of psychosocial factors in the development and management of mechanical back pain. This involves understanding how stress, anxiety, depression, and cognitive-behavioral factors influence pain perception and recovery.
Long-term Outcomes: Investigating the long-term outcomes of individuals with mechanical back pain is essential. Research assesses the progression of symptoms, recurrence rates, and the impact of chronic back pain on patients’ quality of life.
Multidisciplinary Approaches: There is growing interest in multidisciplinary approaches to treating mechanical back pain, which may involve collaboration between physical therapists, psychologists, pain management specialists, and other healthcare providers to address both the physical and psychological aspects of pain.
Research on mechanical back pain is ongoing, as it remains a significant public health concern due to its prevalence and impact on individuals’ daily lives and the healthcare system. Understanding the underlying mechanisms, risk factors, and effective treatments is crucial for improving the management of mechanical back pain and enhancing the quality of life for those affected by it.
*Disclaimer: This information is not a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. The information provided is for educational purposes only and is not intended as a diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice. They do not represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.