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Overview

A rhizotomy is a surgical procedure performed by neurosurgeons which are performed to selectively sever and destroy nerve roots coming out of the spinal cord.

The procedure is performed in order to relieve symptoms in patients caused by conditions such as osteoarthritis, spastic diplegia, cervical dystonia, and other types of spastic cerebral palsy.

Requirements for the Procedure

The following are criteria that need to be fulfilled in order for patients with spastic neurological conditions to be managed with a rhizotomy.

If under 18 years of age:

  • The patient must be at least 2 years old.
  • The patient must be diagnosed with moderately involved or higher levels of spastic hemiplegia, spastic quadriplegia, or spastic diplegia.
  • There must be some form of independent mobility.
  • The patient must have been born prematurely.
  • There must be potential for improvement in functional skills.

If the patient is between 18 and 40 years of age:

  • There must be a history of premature birth.
  • Spastic diplegia must be diagnosed.
  • They must be moving independently without the use of assistive devices
  • There mustn’t be any other orthopaedic deformities that prevent the patient from walking or would prevent them from walking after having the procedure performed
  • There is the potential for gaining some function back after the procedure
  • There’s excellent motivation for the patient to attend physical therapy programs and to perform home exercises after the procedure

Procedure

The following steps take place when a rhizotomy is performed:

  • A one to two-inch incision is made along the centre of the lower back at the height of just above the waist.
  • A procedure called a laminectomy is performed at the first lumbar spine level (L1) where a piece of the bone is removed to gain access to the spinal cord and the nerve roots.
  • Ultrasound and X-rays are performed to find the tip of the spinal cord to help differentiate between the motor and sensory nerves.
  • A rubber pad is then placed between these two main divisions to separate them.
  • The sensory nerve roots will then be placed on top of the rubber pad where they will be tested using electromyography that involves stimulating certain nerve roots to see what the electrical response is to this test. The response is graded from one (mild) to four (severe) and the really problematic nerve roots are identified and selectively destroyed.
  • When the procedure is completed, fentanyl will be administered to the rest of the sensory nerve by bathing them in the medication to numb these nerves.
  • The patient is then closed up and sent to the recovery room for a couple of hours before being taken to the intensive care unit (ICU) to spend around three days for neurological observation.
  • The patient will then be sent to the ward or step-down facility to start with their physical therapy program or may be discharged home to start with their home exercise program.

Outcomes

It usually takes patients around one year from the time the rhizotomy was performed to achieve maximum results.

The procedure doesn’t alleviate any contractures from the spasticity caused by the initial condition but it does help prevent the development of more contractures as well as helping to prevent spasticity which causes increased disability in the patient.

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