A Nurse With Attitude

Where Dark Cynical Humor, Nursing Issues, and Politics Seem to Merge

Surgical Word of the Day is “Rhizotomy”

 This is a procedure of the spine that is to relieve chronic back pain.  It can be either a cervical facet rhizotomy or lumbar facet rhizotomy, (neck or low back).   This is to provide pain relief by “shutting off” the pain signals that the spine joints send to the brain.

In the beginning when surgeons discovered nerves were conductive pathways for both, sensory and movement, they would sometimes resort to cutting the nerve roots to treat severe pain. Unfortunately, this didn’t always have a good outcome. Some patients experienced serious “functional loss,” meaning they lost necessary body functions, such as limb movement.

In the early 1980s  the “rhizotomy procedure” was developed. This is procedure is done using a local anesthetic and x-ray guidance to find the offending nerve. An electrode needle is placed near the small nerves in the back using electrical stimulation. The patient is usually awake so they may voice their displeasure of tickling the correct nerve. Once the correct nerve is isolated, the patient is put to sleep by the anesthesia team. The electrode is then heated, with a technology called radiofrequency (much the same as microwave energy).  This localized heat deadens these nerves that carry pain signals to the brain causing the “ah” sensation of sudden pain relief, and at the same time, minimizing motor skill weakness.  The rhizotomy is done as an outpatient procedure and takes about 30-60 minutes.  
Many of my patients are concerned that if their nerves have been “cooked” through RF, they will lose normal feeling. They fear that they won’t be able to control their movements as well. For them, I offer a tiny bit of reassurance: the nerves treated with radiofrequency rhizotomy transmit specific pain signals, not signals that control movement, balance, or normal sensation. RF cuts off pain signals sent by the facet joints, so if you injure another part of your neck—strain a muscle, for instance—you’ll still feel that just fine.



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