Surgical intervention for reducing spasticity with its different types and applications has been discussed

1. RHIZOTOMY
Prof. (Dr.) Nidhi Sharma
Professor
MMIPR, MM (DU)

2. What is Rhizotomy?
• Rhizotomy is a neurosurgical procedure that involves severing nerve roots in
the spinal cord.
• Used primarily to relieve chronic pain or spasticity in conditions like cerebral
palsy, multiple sclerosis, and spastic diplegia.
• The procedure can lead to significant improvements in mobility and
function, particularly in children and adults with severe spasticity.
• It is a precise and targeted approach that aims to enhance quality of life.

3. Anatomy and Physiology of Nerve Roots
• The spinal cord consists of motor and sensory nerve roots.
• Motor roots control voluntary muscle movements.
• Sensory roots transmit pain and other sensory signals.
• Rhizotomy selectively interrupts problematic nerve pathways to achieve
therapeutic effects.

4. Types of Rhizotomy
• Radiofrequency Rhizotomy:
• Uses heat generated by radiofrequency waves to disrupt pain-transmitting nerve fibers.
• Commonly used for conditions like trigeminal neuralgia and facet joint pain.
• Minimally invasive with rapid recovery and effective pain relief.
• Endoscopic Rhizotomy:
• A modern, minimally invasive technique using an endoscope to visualize and sever problematic nerve
roots.
• Used for spinal pain syndromes and chronic pain management.
• Less tissue disruption, leading to faster recovery times.

5. Types of Rhizotomy
• Selective Dorsal Rhizotomy (SDR):
• Targets selective nerve roots to reduce
spasticity.
• Commonly used in children with
cerebral palsy.
• Requires careful selection of candidates
based on clinical evaluation and gait
analysis.

6. Types of Rhizotomy
• Percutaneous Rhizotomy:
• Minimally invasive approach,
often used for trigeminal
neuralgia.
• Uses radiofrequency ablation to
selectively disrupt nerve
function.

7. Indications for Rhizotomy
• Spasticity due to cerebral palsy, spinal cord injury, or stroke.
• Chronic pain syndromes like trigeminal neuralgia.
• Patients with significant functional impairment due to spasticity.
• When conservative treatments fail, such as medication, botulinum toxin injections,
or physiotherapy.
• Individuals with severe spasticity that hinders normal daily activities or causes
discomfort.
• Used when non-surgical methods are ineffective.

8. Patient Selection Criteria
• Detailed preoperative assessment including imaging and functional
testing.
• Patients with persistent spasticity interfering with mobility.
• Candidates should have a good rehabilitation support system.
• Consideration of alternative treatments before surgery.

9. Procedure Overview
• Preoperative Evaluation:
• Neurological and functional assessment.
• Imaging studies (MRI, CT scan) to identify affected nerve
roots.
• Gait analysis and electrophysiological testing for SDR
candidates.

10. Procedure Overview
• Surgical Steps:
• Patient under general anesthesia.
• Identification of nerve roots via intraoperative monitoring and
electromyography (EMG).
• Selective cutting of affected nerve roots while preserving
motor function.

11. Procedure Overview
• Postoperative Care:
• Pain management with medications.
• Intensive physiotherapy and rehabilitation.
• Monitoring for complications such as sensory deficits or
weakness.

12. Benefits of Rhizotomy
• Reduction in muscle spasticity, leading to improved range of motion.
• Enhanced mobility and functional independence.
• Decreased need for orthopedic surgeries in the future.
• Better posture and ease of performing daily activities.
• Long-term relief with minimal recurrence when combined with therapy.
• Improved ability to participate in daily and recreational activities.

13. Risks and Complications
• Temporary or permanent sensory loss in the treated area.
• Weakness in treated limbs, requiring postoperative physiotherapy.
• Infection or bleeding at the surgical site.
• Bowel or bladder dysfunction (rare but possible).
• Risk of overcorrection, leading to excessive weakness or instability.
• Need for extensive rehabilitation to maximize functional benefits.
• Psychological impact and adjustment post-surgery.

14. Rehabilitation Post-Rhizotomy
• Physiotherapy: Strengthening, stretching, and gait training.
• Occupational Therapy: Focus on improving fine motor skills and daily function.
• Speech Therapy: If necessary for cases involving cranial nerve rhizotomy.
• Psychological Support: Coping strategies and motivation for long-term therapy
commitment.
• Long-Term Follow-Up: Periodic assessments to ensure sustained improvements and
address any issues.
• Home Exercise Programs: Encouragement for continued functional improvement.

15. Conclusion
• Rhizotomy is an effective surgical option for managing spasticity and pain.
• Careful patient selection is crucial for optimal outcomes.
• Postoperative rehabilitation plays a vital role in maximizing benefits.
• Advancements in neurosurgical techniques continue to improve safety and
efficacy.
• Continued research is essential to enhance patient outcomes and refine
techniques.