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PM dr and Rhizotomy

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:25 AM in Back Surgery and Neck Surgery
I guess I am nervous and unsure of this next procedure...I just had a PM visit and she now thinks a rhizotomy will help me. She was in and out of the room too fast and I was not clear on which lumbar disk or nerve. She said the other dr who does the steroid injections will do the procedure in 2 stages. 1st step is to inject numbing medication and then come back for the rhizotomy.

I did have surgery years ago for herniated discs, tethered spinal cord with a lipoma in my lumbar area from L2 to L5. I am willing to undergo this procedure but I am not clear if I should see someone beside the other PM dr? I can't help but wonder why I never had this done before as I have severe pain for many years..

Does anyone have any feedback on a rhizotomy? I am a little afraid.... :SS :SS jade


  • The procedure is actually fairly simplistic. The first stage where they inject the anesthetic is to make sure that a.) they have the right nerve and b.) that by targeting that nerve they are able to target your pain. If that is successful then they will go back in under fluoroscopic guidance and first stimulate the nerve to once again make sure they have targeted the right nerve and then burn the nerve using radio frequency ablation.

    Depending on doctors and pain clinics, some try this first and others wait until after. I'm not sure what their reasoning is.

    I've had 6 and have gotten relief from some.

  • C- thanks for the info. I sure hope it is not like a discogram where they stimulated the disc to see if they could reproduce or maybe induce pain. That was unbelievably painful. :jawdrop:

    I now remember the dr saying a flouroscope for the 2nd step. She made it sound like I had to have a trial 1st and then come back another day for the rhizotomy.

    Is there any type of anesthesia or is another stone cold sober procedure?.. :SS :SS jade
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  • hi jade,
    sorry you have to go through this >:D<
    iv never had it. but my the pain managment dr that gave me my SI joint injection said he would do that procedure if the SI did not work 2'x's.
    he said it was done in the hospital, and i would have IV concious sedation. im not good with concious sedation (due to a high tolerance to pain medication) Examaple: versad and fentynl or some other type of relaxant and pain med.
    so personally that will never be a option for myself.
    call them monday and mabye one the nurses can explain to you how its all going to take place.
    mine said it would all be done in one procedure not 2 separate times. hmmm :? :? :? that has me curious :?

    good luck hun!!
  • }:) I have had several and they have been done differently so it depends on the doc. I have had an IV to be "relaxed" and also no IV just local anesthesia. First they find the nerve, then inject more numbing stuff and then burn the end of the nerve. Its painful since you have to be able to tell them if it hurts, but it doesn't last long and can give you relief. It is done under a fluoroscope and depending on how many levels have to be done, its a relatively short procedure. Good luck!!


    14 surgeries including L4/L5 laminectomy, L4/L5 360 fusion with instrumentaion, L1-L5 fusion with hardware and auto bone graft, numerous cortisone injections and rhyzotomys, prolotherapy and PT.
    L4/L5 laminectomy, L4/L5 360 fusion with instrumentation, L1 to L5 fusion, L5/S1 fusion w/ disc replacement, left and right SI joints fused.
  • I am guessing I better talk to someone in the office to find out. I was under the impression they do the rhizotomy over 2 days. I could be wrong but the PM dr said to schedule the trial.
    And if it is a procedure where I am awake and get to tell them if it hurts, then I know that I will be screaming with the nurses holding me down. :''( ~X(
    But if it is with some type of sedation, then I will try it but stone cold sober, then no way until I find a dr who uses sedation. :B
    I have tried many procedures where I was told it would hurt a little. Wrong, they usually hurt a whole lot and I don't want to be screaming and crying if I know this can be avoided. :SS jade
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  • All pain clinics and PM docs do things similar but different. The PM docs that have done my rhizotomies have all done diagnostic nerve blocks a day or more before the actually procedure.

    The first one I had zero IV sedation. The last 5 since they were all done at the same time, included IV sedation.

    The doc's office should be able to clear up the confusion for you.

  • My PM doctor first did a nerve block...it helped but didn't last long. He then said a rhyzotomy should help.
    It is done under sedation: they locate the areas, wake you up to ask if it hurts...then you go back to sleep while they burn the nerves.
    I had the first series in 2006 and just needed to have it again. Two years without lumbar pain was pretty good!
  • I too have just had a prescription for both Facet Injections and the Rhizotomy. I have pain in thoracic and lumbar. I am really leary of the pain issue and plan to ask for sedation. The last entry by dbullwenkel sounds much better if they sedate, wake to see if there is pain and then back to sleep.
    I will definitely check on this before any procedure. Thank you for that info. I have had cervical discectomy w/fusion a couple of years ago and possibly will have to have injections there as well. Since I have more degenerated discs above and below the metal cage. Boy oh boy! the pain we go through to eliminate the pain!! I hope it works for you Jade2....the neurosurgeon who prescribed this said pain wasn't really bad...hmmmmm...but there would be soreness afterwards. I wonder?
  • Hopefully, you have a relationship with your PM that when you say "that's..OOOCH" he treats you immediately - the nice thing about having an IV in is that CRNA or anesthesiologist will be right there to push the meds when the PM says to - and IV fentanyl works almost instantly. So will there be pain - yes, but let your doc know what you can & can't handle.
    My impression is that rhizotomies/neurotomies are used when facet blocks are positive in producing relief. I had one that caused significant pain for two weeks after...last time my surgeon added just a little steroid to the area most bothersome to me after the burning and it made a world of difference in the post-rhizotomy recovery, but I don't believe its routine practice with PM's.
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