rhizotomy

Rhizotomy is a neurosurgical procedure that involves destroying or severing one or more nerve roots to relieve pain or reduce abnormal motor function such as spasticity. It can target dorsal (sensory) or ventral (motor) nerve roots at the spinal cord, and in some contexts it includes cranial or peripheral nerve roots. Procedures may be open and direct or performed percutaneously to create a controlled lesion.

Common forms include dorsal root rhizotomy for pain or spasticity, and selective dorsal rhizotomy (SDR), a specialized procedure for children with cerebral palsy that identifies and cuts certain sensory rootlets to lessen spasticity and improve mobility. Ventral root rhizotomy targets motor roots to decrease involuntary muscle activity in selected cases. Cranial nerve rhizotomies, such as those for trigeminal neuralgia, may use chemical (glycerol), radiofrequency, or balloon compression techniques to lesion the sensory root.

Techniques vary from open microsurgical dissection to percutaneous chemical lesions (phenol or alcohol) and thermal lesioning (radiofrequency ablation or laser). Stereotactic radiosurgery provides a noninvasive option to lesion a nerve root. The choice of method depends on the nerve involved, the underlying condition, and the goal of treatment.

Indications include intractable neuropathic or cancer-related pain that has failed conservative management, disabling spasticity or dystonia unresponsive to other therapies, and certain cranial nerve–related pain syndromes. Rhizotomy is generally considered when potential benefits outweigh risks, and it may provide substantial relief for selected patients but carries risks such as sensory or motor loss, weakness, paresthesias, infection, or anesthesia complications.

Recovery and prognosis vary with the specific indication and technique, but outcomes range from significant symptom relief to partial or transient benefit.