Cervical rhizotomies are necessary when the facet joints (small joints between the back parts of the vertebral bones) in the neck are the cause of frequent neck pain. Rhizotomies are considered on patients who have taken three sets of anesthetic tests. The pain must decrease with the anesthesia and remain unchanged when placebos are used.
A rhizotomy is the destruction of nerves within the facet joints of the neck. It is normally done by burning them with a radiofrequency current. This eliminates the pain sensations and is considered as an option only when the pain is due to facet joint disorders. The objective with a cervical rhizotomy is to reduce pain in cases of facet joint degeneration.
Joint degeneration normally goes unnoticed because there are no pain sensors located in the cartilage around the joints. The pain nerves are located within the bones, and so when joint degeneration happens, it doesn’t start causing pain until it progresses to the bones. Because each facet contains nerves from two different joints, the burning of one set of nerves may not eliminate or help to reduce pain.
A rhizotomy is performed by the patient first being given a sedative or anesthetic, and then positioned underneath a fluoroscope, which is a type of X-ray machine. The skin around the surgery site is numbed and then, with the use of the fluoroscope, a needle is inserted into the body and used to target the nerves conducting pain. Then a wire is put through the needle until it is at the nerves; then a small amount of radiofrequency electricity is released onto the nerves, burning them. The radiofrequency causes nerve death in order to promote improvement in or elimination of pain due to joint degeneration and can provide relief for months or years to the patient, according to the Northern California Neurosurgery Medical Group's website. After the surgery, patients can expect to experience some pain and discomfort. Bruising, swelling and soreness at the injection site is common. Pain from the procedure will last for a few days after the surgery, but patients should notice continuous improvement each day.
Serious complications are rare with this procedure, but signs of serious complication include chills, dizziness, weakness, numbness that lasts more than three hours, bleeding, drainage, or prolonged pain at the injection site, and fever. As with all types of surgery, infection is always a risk. Infections may be indicated by redness or swelling around the injection site, and pus.
In order for a rhizotomy to be the best option in any given case, there are certain criteria points that need to be met. Pain must be localized and not radiate into other parts of the body or show signs of compression of nerves. The pain must have no response to non-surgical treatments for more than a year. Pain must be tested and doctors assured that the pain is indeed from the facets and not other causes like an organic alteration of the spine. Pain should be tested with anesthetics. If the anesthetic tests work and the pain is relieved, then a rhizotomy is considered.