Rhizotomy

Treatment Information

What is a rhizotomy?

A rhizotomy is a procedure that uses a temperature probe to apply heat to the nerve to "burn the nerve." This will interrupt the sensory nerve pathway and decrease the pain. Before a rhizotomy procedure is preformed, a patient must first have a two positive diagnostic blocks with and without different local anesthetics. If so, only then is a patient a candidate for this procedure. This procedure is designed to provide pain relief on a long-term basis when the diagnostic block only provided short-term relief.
A pulse rhizotomy is used in the same manner; however, rather than using a heat probe, electromagnetic waves are used to create the same effect.

 

Why is a rhizotomy performed?

A rhizotomy procedure can offer improvement in pain on a long-term basis if the diagnostic block offered significant, but temporary improvement in the pain. Most rhizotomy procedures are used to help with facet joint related pain in the spine that is facet mediated. On average, a rhizotomy procedure can provide improvement in pain up to one year. With a pulse rhizotomy, the pain improvement can last between 3-6 months.

 

Why would a rhizotomy NOT be performed?

A rhizotomy procedure will NOT be performed if you have an active infection, fever, bleeding problems, allergy to the local anesthetic and steroid, and/or pregnancy.

 

What are the preparations for the procedure?

Before the procedure, you are asked NOT to eat four (4) hours prior and NOT to drink liquids two (2) hours prior to your procedure time. You must have someone of age to drive you home following your procedure, as you will not be permitted to drive a vehicle on the day of your procedure. Anyone who is taking a blood thinning medication such as coumadin will be required to stop that medication for 3-5 days before the procedure, plavix requires stopping 7 days before the procedure. Otherwise, you may take your regularly prescribed medications the morning of your procedure with a sip of water. If you are a diabetic patient, you may eat a limited amount before your procedure to avoid hypoglycemia.

IF YOU ARE A PATIENT WITH AN IMPLANTED PACEMAKER OR A SPINAL CORD STIMULATOR, IT IS IMPERATIVE THAT YOU NOTIFY THE PHYSICIAN BEFORE THE START OF THE PROCEDURE. THIS PROCEDURE CAN INTERFERE WITH THE FUNCTION OF BOTH DEVICES AND MAY CAUSE SERIOUS SIDE EFFECTS. ALSO BRING MAGNET TO TURN OF GENERATOR AND PACEMAKER OR SPINAL CORD STIMULATOR.

 

What happens during the procedure?

After the procedure and complications have been explained by the physician or physician assistant, an informed consent paper, (giving permission for the procedure), must be signed by the patient. Then, the patient will be sedated with oral medications or with IV medications to help with anxiety related to the procedure. Once in the procedure room, the patient will be placed face down on the x-ray table. The patient will not be put to sleep for this procedure, as it is very important for the patient to answer questions during the procedure. The area to be injected will be cleaned with an antiseptic solution, which is usually betadine unless you are allergic to this. Numbing medicine will be injected under the skin to numb the area to be injected.

The physician will then guide the needle into the appropriate position under x-ray. Once in place, the physician will test the sensory nerve of each target area. During this time, the physician will be asking questions, and it is VERY important for the patient to listen and answer appropriately. The patient should only feel sensations in the area of injection and not elsewhere, such as in the extremities. Then motor stimulation will be carried out, which feels like thumping or pulsation, this should also only be felt in the area of pain. Once all views of fluoroscopic guidance confirm that the probes are in the correct location area to be burned will be anesthetized with Lidocaine. After this has been completed the nerve will be burned with heat generated by radio frequency waves. It is at this time that the nerve is being burned and you will be ask during the burning of the nerve where you are feeling it. It you feel anywhere other than area of pain let the physician know. Once completed, local anesthetic and steroid medication is injected to help reduce inflammation at this site.

 

How long does the procedure take?

The rhizotomy can take between 15-25 minutes depending on the number of levels to be performed.

 

What are possible complications from the procedure?

This procedure does come with risks. Complications that can occur include but are not limited to bruising, hematoma, infection, and reaction to the steroid and traumeel medications.

 

What are possible side effects of steroid medication?

Administration of steroid medication can cause side effects. Side effects can include but not limited to hyperglycemia, altered menstrual cycle, fluid retention, bruising, insomnia, sweats, hot/cold flashes, flushing of the face, weight gain, epidural lipomatosis, steroid myopathy, avascular necrosis of bone, osteoporosis, and Cushing’s syndrome.

 

What happens after the procedure?

After the procedure is completed, the patient is taken to the recovery area. There, you will be monitored closely by checking the blood pressure, heart rate, and pain score level. You may be given something to drink during this time. Also, the staff will be observing for any side effects from the procedure. You will be given discharge instructions and any follow-up information that is needed. Swelling is a common occurrence after this procedure. This can cause increased pain, muscle spasms, numbness and tingling for up to 10-14 days following the procedure. Over time, these symptoms will resolve, and your pain will decrease.

 

Important Notes

  • If you suspect you might be pregnant or know you are pregnant, please notify the physician or any staff member prior to any injection.
  • If you are a diabetic patient taking insulin or pills to manage your diabetes, the steroid used in the joint injection can raise your blood sugar level temporarily. You should monitor your blood sugar level closely after your injection. If your blood sugar level continues to be elevated then contact your primary care physician for suggestions on how to best manage this issue.
  • After the injection, you should resume your regular medications as you are prescribed if those medications were stopped before the injection.

* If you do not understand any part of the above material, please discuss it with your physician or physician assistant. *

 

Related Information

Other Treatments

 

Related Documents

Discharge Instructions

Patient Pain Diary

 

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