A Brief Guide To Cervical Rhizotomy

Cervical rhizotomy, also known as cervical facet rhizotomy is a simple medical procedure used to stop chronic neck pain. Sometimes accompanied by a similar treatment known as paraspinal injection, this procedure is performed by a physician specializing in a field known as neurointerventional surgery, but the procedure does not require "surgery" in the traditional sense.

A needle is inserted into the neck to a facet, or point, on the spine in the neck that has previously been found to be generating pain. The needle generates radiofrequency radiation that heats the nerve and deadens it, blocking pain signals until the nerve recovers, usually keeping the patient pain-free for 3 to 6 months.

Who Is a Likely Candidate for Cervical Rhizotomy?

We don't usually think of the neck as containing joints, but 24 of 33 vertebrae that make up the spine are "articulating," capable of bending, slightly, so the neck and the upper body can move. The 9 vertebrae in the sacrum and the coccyx, or "tailbone," are imbedded in bone and fixed so that they do not move with the motion of the body.

Like joints elsewhere in the body, the joints in the spine can slowly wear out. The damage to the joint does not cause pain, however, until it begins to affect not just the cartilage that connects the spine to muscles but the bone itself. The nerves are in the bone, not in the cartilage. Damage to a joint is likely to be very advanced before it causes pain, and the things one might do to keep a joint in good condition are generally too late to prevent neck pain.

When the deteriorating joints are located in the cervical spine, that is in the vertebrae of the neck, severe joint damage can present a baffling combination of symptoms. Symptoms of facet joint arthritis of the cervical spine include:

• Neck pain. Neck pain is usually worse when nodding, moving the head from side to side, or bowing.
• Headaches. These headaches usually occur at the sides of the head.
• Muscle spasms in the neck. Usually muscle spasms are focal rather than "all over" the neck.

Pain Relief, Rather than Reconstruction

Cervical rhizotomy is all about relieving pain, rather than repairing the joint. When the effects of the procedure wear off, it has to be repeated. On the other hand, cervical rhizotomy can relieve pain that isn't necessarily caused by deterioration of the joint. It might be used to buy time so a deteriorated disk can heal, or it might even be used to control referred pain caused by procedures one ordinarily would not associate with neck pain, such as gall bladder surgery and dental work.

What Happens During Cervical Rhizotomy?

Cervical rhizotomy is a surgical procedure. It is a procedure that has to be performed by a medical doctor, although a chiropractor may be on the treatment team. 

Cervical rhizotomy is usually offered as day surgery. You go in for the procedure, and then a friend or family member drives you home after you get out of the recovery room.

Just about the first thing that will happen when you get into the surgery room is you will be given an IV port. This is just a precaution in case you are one of a very, very few people who has an allergic reaction to lidocaine, the medication used to numb the neck before the surgeon introduces the radiofrequency ablation needle.

Then, using a fluoroscope so he or she has an image of the bones in your neck, the surgeon introduces a needle at the edge of the nerve that is conducting pain messages to your brain. This is typically a 22-gauge needle, the same size needle. It's not as thick as the used for your IV (which is typically 18- or 20-gauge). It's about the same size needle as is used for a flu shot.

You may experience a buzzing, tingling, or vibrating sensation as the doctor confirms that the needle has been placed at the correct nerve. Then for 1 to 2 minutes the doctor "zaps" the nerve so the transmission of pain signals stops. Sometimes the doctor will also inject a small amount of a steroid injection into the site of the procedure to prevent swelling and inflammation. This is the "paraspinal injection."

And that's it. Usually pain relief begins about 15 minutes after the procedure, but sometimes it takes about a week. But it's important to understand that you almost certainly won't get 100% pain relief rom the procedure.

Typically, cervical rhizotomy leaves the patient with less pain, not no pain. It may be possible to function with less pain medication, and it may be possible to tolerate more activity or to move the neck through a greater range of motion. 

It is also vital to understand that cervical rhizotomy offers relief, not cure. Pain usually begins to come back in about 3 months, and after 4 months, most people are ready for another round of treatment.

The nerves that are numbed by radiofrequency ablation typically regenerate themselves in just a few months. During those 3 to 4 months, however, you may experience sufficient reduction of pain that you just do not remember feeling as good--losing pains that you had even forgotten you had.