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Rhizotomy

Rhizotomy

Definition

Rhizotomy is the cutting of nerve roots as they enter the spinal cord.


Purpose

Rhizotomy (also called dorsal rhizotomy, selective dorsal rhizotomy, and selective posterior rhizotomy) is a treatment for spasticity that is unresponsive to less invasive procedures.


Demographics

Spasticity (involuntary muscle contraction) affects many thousands of Americans, but very few are affected seriously enough to require surgery for its treatment.


Description

Rhizotomy is performed under general anesthesia. The patient lies face down. An incision is made along the lower spine, exposing the sensory nerve roots at the center the spinal cord. Individual nerve rootlets are electrically stimulated. Since these are sensory nerves, they should not stimulate muscle movement. Those that do (and therefore cause spasticity) are cut. Typically, onequarter to one-half of nerve rootlets tested are cut.


Diagnosis/Preparation

Rhizotomy is performed on patients with spasticity that is insufficiently responsive to oral medications or injectable therapies (botulinum toxin, phenol, or alcohol). It is most commonly performed for those patients with lower extremity spasticity that interferes with walking or severe spasticity that prevents hygiene or positioning of the legs. It is most commonly performed on children with cerebral palsy.

Patients undergoing rhizotomy receive a large battery of tests before the procedure, in order to document the functional effects of spasticity, and the patient's medical health and likely response to anesthesia and other operative stresses. Rhizotomy is performed as an in-patient procedure, and the patient is likely to require an overnight hospital stay before the operation.


Aftercare

After surgery, the patient will spend one to several days in the hospital. Physical therapy and strength training usually begin the next day, in order to maximize the gains expected from surgery, and to keep the limbs mobile. Medication may be given for pain.


Risks

Rhizotomy carries small but significant risks of nerve damage, permanent loss of sensation or altered sensation, weakness of the lower extremities, bowel and bladder dysfunction, increased likelihood of hip dislocation, and scoliosis progression. Anesthesia carries its own risks.


Normal results

Rhizotomy reduces spasticity, which should allow more normal gait and improve mobility. Patients may require fewer walking aids, such as walkers or crutches.

Morbidity and mortality rates

Other than the risks from anesthesia, rhizotomy does not carry a risk of death during surgery. Morbidity rates vary among centers performing the surgery. Persistent and significant adverse effects may occur in 15% of patients, including bowel or bladder changes and low back pain.


Alternatives

Other spasticity treatments include oral medications and an implanted pump delivering baclofen to the space around the spinal cord (intrathecal baclofen). These may be appropriate alternatives for some patients. Orthopedic surgery can correct deformities that occur from untreated spasticity. Some controversy exists whether rhizotomy can delay or prevent the need for other spasticity procedures, especially orthopedic surgery such as tenotomy , with some evidence suggesting it can, and other evidence suggesting it may not.


Resources

organizations

United Cerebral Palsy. 1660 L Street, NW, Suite 700, Washington, DC 20036. (800) 872-5827 or (202)776-0406. TTY: (202) 973-7197. Fax: (202) 776-0414. [email protected] ucp.org. <http://www.UCP.org>.

WE MOVE. <http://www.wemove.org>.


Richard Robinson

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Rhizotomy is performed by a neurosurgeon in a hospital. The patient's neurologist and physical therapist may also be in attendance to help with the evaluation during surgery.

QUESTIONS TO ASK THE DOCTOR



  • How many rhizotomies have you performed?
  • What is your complication rate?
  • Is orthopedic surgery still likely to be necessary later on?

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"Rhizotomy." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. . Retrieved November 21, 2018 from Encyclopedia.com: https://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/rhizotomy

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rhizotomy

rhizotomy (ry-zot-ŏmi) n. a surgical procedure in which selected nerve roots are cut at the point where they emerge from the spinal cord. The posterior (sensory) nerve roots are cut for the relief of intractable pain; the anterior (motor) nerve roots are sometimes cut for the relief of severe muscle spasm or dystonia.

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Notes:
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  • In addition to the MLA, Chicago, and APA styles, your school, university, publication, or institution may have its own requirements for citations. Therefore, be sure to refer to those guidelines when editing your bibliography or works cited list.

Rhizotomy

Rhizotomy

Definition
Purpose
Demographics
Description
Diagnosis/Preparation
Aftercare
Risks
Normal results
Morbidity and mortality rates
Alternatives

Definition

Rhizotomy is the cutting of nerve roots as they enter the spinal cord.

Purpose

Rhizotomy (also called dorsal rhizotomy, selective dorsal rhizotomy, and selective posterior rhizotomy) is a treatment for spasticity that is unresponsive to less invasive procedures.

Demographics

Spasticity (involuntary muscle contractions) affects many thousands of Americans, but very few are affected seriously enough to require surgery for its treatment.

Description

Rhizotomy is performed under general anesthesia. The patient lies face down. An incision is made along the lower spine, exposing the sensory nerve roots at the center the spinal cord. Individual nerve rootlets are electrically stimulated. Since these are sensory nerves, they should not stimulate muscle movement. Those that do (and therefore cause spasticity) are cut. Typically, one-quarter to one-half of nerve rootlets tested are cut.

Diagnosis/Preparation

Rhizotomy is performed on patients with spasticity that is insufficiently responsive to oral medications or injectable therapies (botulinum toxin, phenol, or alcohol). It is most commonly performed for those patients with lower extremity spasticity that interferes with walking or severe spasticity that prevents hygiene or positioning of the legs. It is most commonly performed on children with cerebral palsy.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Rhizotomy is performed by a neurosurgeon in a hospital. The patient’s neurologist and physical therapist may also be in attendance to help with the evaluation during surgery.

Patients undergoing rhizotomy receive a large battery of tests before the procedure, in order to document the functional effects of spasticity, and the patient’s medical health and likely response to anesthesia and other operative stresses. Rhizotomy is performed as an in-patient procedure, and the patient is likely to require an overnight hospital stay before the operation.

Aftercare

After surgery, the patient will spend one to several days in the hospital. Physical therapy and strength training usually begin the next day, in order to maximize the gains expected from surgery, and to keep the limbs mobile. Medication may be given for pain.

Risks

Rhizotomy carries small but significant risks of nerve damage, permanent loss of sensation or altered sensation, weakness of the lower extremities, bowel and bladder dysfunction, increased likelihood of hip dislocation, and scoliosis progression. Anesthesia carries its own risks.

Normal results

Rhizotomy reduces spasticity, which should allow more normal gait and improve mobility. Patients may require fewer walking aids, such as walkers or crutches.

Morbidity and mortality rates

Other than the risks from anesthesia, rhizotomy does not carry a risk of death during surgery. Morbidity rates vary among centers performing the surgery. Persistent and significant adverse effects may occur in 1-5% of patients, including bowel or bladder changes and low back pain.

QUESTIONS TO ASK THE DOCTOR

  • How many rhizotomies have you performed?
  • What is your complication rate?
  • Is orthopedic surgery still likely to be necessary later on?

Alternatives

Other spasticity treatments include oral medications and an implanted pump delivering baclofen to the space around the spinal cord (intrathecal baclofen). These may be appropriate alternatives for some patients. Orthopedic surgery can correct deformities that occur from untreated spasticity. Some controversy exists whether rhizotomy can delay or prevent the need for other spasticity procedures, especially orthopedic surgery such as tenotomy, with some evidence suggesting it can, and other evidence suggesting it may not.

Resources

ORGANIZATIONS

United Cerebral Palsy. 1660 L Street, NW, Suite 700, Washington, DC 20036. (800) 872-5827 or (202)776-0406. TTY: (202) 973-7197. Fax: (202) 776-0414. [email protected] http://www.UCP.org.

WE MOVE. http://www.wemove.org.

Richard Robinson

Rhytidoplasty seeFace lift

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"Rhizotomy." The Gale Encyclopedia of Surgery and Medical Tests. . Encyclopedia.com. 21 Nov. 2018 <https://www.encyclopedia.com>.

"Rhizotomy." The Gale Encyclopedia of Surgery and Medical Tests. . Encyclopedia.com. (November 21, 2018). https://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/rhizotomy-0

"Rhizotomy." The Gale Encyclopedia of Surgery and Medical Tests. . Retrieved November 21, 2018 from Encyclopedia.com: https://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/rhizotomy-0

Learn more about citation styles

Citation styles

Encyclopedia.com gives you the ability to cite reference entries and articles according to common styles from the Modern Language Association (MLA), The Chicago Manual of Style, and the American Psychological Association (APA).

Within the “Cite this article” tool, pick a style to see how all available information looks when formatted according to that style. Then, copy and paste the text into your bibliography or works cited list.

Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia.com cannot guarantee each citation it generates. Therefore, it’s best to use Encyclopedia.com citations as a starting point before checking the style against your school or publication’s requirements and the most-recent information available at these sites:

Modern Language Association

http://www.mla.org/style

The Chicago Manual of Style

http://www.chicagomanualofstyle.org/tools_citationguide.html

American Psychological Association

http://apastyle.apa.org/

Notes:
  • Most online reference entries and articles do not have page numbers. Therefore, that information is unavailable for most Encyclopedia.com content. However, the date of retrieval is often important. Refer to each style’s convention regarding the best way to format page numbers and retrieval dates.
  • In addition to the MLA, Chicago, and APA styles, your school, university, publication, or institution may have its own requirements for citations. Therefore, be sure to refer to those guidelines when editing your bibliography or works cited list.