Rhizotomy / Cordotomy

Surgical procedures in which pain-nerve pathways are cut to reduce severe pain or muscle contraction that does not respond to other methods.

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Interventional Pain Treatment

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1Overview

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What is this Condition?

Rhizotomy and cordotomy are procedures performed by targeted cutting or inactivation of nerve pathways that carry pain signals. In rhizotomy, some of the sensory nerve roots entering the spinal cord are cut; this reduces pain in specific areas and can also be used to relieve excessive muscle contraction (spasticity). In cordotomy, the pathway in the spinal cord that carries pain to the brain is inactivated, reducing pain sensation on the opposite side of the body. These procedures are usually considered for very severe pain (especially some advanced cancer pain) or serious muscle contraction situations where medication, physical therapy, or other methods are insufficient. Which method is appropriate is carefully evaluated based on the patient's condition.

Symptoms

In advanced cancer, severe pain concentrated on one side of the body that does not respond to medication (cordotomy)

Patients unable to tolerate side effects of strong analgesics such as nausea, constipation, and drowsiness

Excessive muscle contraction (spasticity) due to cerebral palsy or spinal cord injury that cannot be controlled with medication — particularly selective rhizotomy in children

Localized, refractory nerve-origin pain in a specific region that does not respond to other treatments

Situations where other pain methods (battery-stimulation system, drug pump) have been tried and are insufficient

For cordotomy: pain being unilateral and absence of contraindications such as respiratory problems

Diagnosis Methods

Since these are treatment methods, evaluation emphasizes the type, severity, and location of pain or contraction, and which treatments have been tried previously. Pain specialist and neurosurgeon conduct joint evaluation; in cancer pain, whether the pain is unilateral and the patient's general condition are important. In spasticity, neuromonitoring is used during the procedure to understand which nerve roots affect the muscles. Respiratory status and bleeding risk are also reviewed before the procedure.

Treatment Methods

The method is selected based on the patient's condition. In cancer pain, the most commonly preferred is closed (percutaneous) cordotomy performed from the neck region, under imaging guidance, with the patient awake; a fine needle targets the pain pathway and inactivates it with thermal energy. In spasticity, selective rhizotomy is applied: with the aid of neuromonitoring during the procedure, some of the nerve root fibers causing excessive contraction are cut, thereby reducing muscle tone while attempting to preserve sensation and strength. Expectations and possible outcomes are discussed in detail with the patient before the procedure. In some cases, pain may return after a period of time.

Closed (percutaneous) cordotomy: inactivation of the pain pathway with thermal energy from the neck under imaging guidance — particularly in unilateral cancer pain

Selective rhizotomy: partial cutting of sensory nerve root fibers causing excessive muscle contraction with neuromonitoring

In facet joint pain, inactivation of the associated small nerve with thermal energy

In inappropriate situations, alternatives: reversible methods such as drug pump or spinal cord stimulation system

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

4 links

Selektif dorsal rizotomi

Selektif dorsal rizotomi procedure

Open treatment detail

Perkütan kordotomi

Perkütan kordotomi procedure

Open treatment detail

Açık kordotomi

Açık kordotomi procedure

Open treatment detail

Gasserian Ganglion Block

Nerve block for pain control in the trigeminal ganglion region

Open treatment detail

References

Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023:1878–1879.
Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023:1852.
Functional Neurosurgery and Neuromodulation. 2019:248.
Treatment of Chronic Pain by Interventional Approaches. 2015:248.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Rhizotomy / Cordotomy

Interventional Pain Treatment

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Selektif dorsal rizotomi

Perkütan kordotomi

Açık kordotomi

Gasserian Ganglion Block

References

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Selektif dorsal rizotomi

Perkütan kordotomi

Açık kordotomi

Gasserian Ganglion Block

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