Rhizotomy: A Comprehensive Guide to Managing Chronic Pain and Spasticity

Oct 7

7 min read

Updated: 3 days ago

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer: What is a rhizotomy?

A rhizotomy is a procedure that relieves persistent pain or muscle spasticity by disabling the specific nerve roots causing it, using surgical cutting, chemicals or radiofrequency heat. [1] It is mainly used when conservative treatments have not worked. [1] Most people get long-lasting pain relief or significant improvement in spasticity, though some get little to no relief. [1]

Illustration of the spine with a thin needle probe placed at a small branch of a spinal nerve beside the vertebrae, as used in radiofrequency rhizotomy. – rinnit.com — In a radiofrequency rhizotomy, a thin probe is guided to a small spinal nerve branch to interrupt its pain signals.

What the research says

Selective dorsal rhizotomy improves movement and reduces spasticity in children with cerebral palsy. A review of 16 studies (756 children) found that gross motor function scores (GMFM-66) rose by an average of 3.29 points at the shortest follow-up and 3.71 points at the longest, and spasticity scores (Modified Ashworth Scale) fell by an average of 1.98 points (Pereira et al., J Neurosurg Sci, 2026) [2].
Radiofrequency treatment of facet joint nerves eased low back pain more than placebo in trials. In a meta-analysis of 8 placebo-controlled trials, pain scores were lower with radiofrequency by about 1.0 point in the short term (under 3 months), 1.4 points at 3 to 12 months, and 1.1 points beyond 12 months, and disability scores improved as well; quality-of-life results were inconclusive (Láinez Ramos-Bossini et al., Radiol Med, 2024) [3].
Not every guideline agrees on radiofrequency for chronic spine pain. An international guideline panel issued strong recommendations against joint radiofrequency ablation for chronic neck or back pain (3 months or longer, not caused by cancer or inflammatory arthritis), based on a linked systematic review and network meta-analysis of randomized trials. Talk with your provider about the evidence for your type of pain (Busse et al., BMJ, 2025) [4].

What is rhizotomy, and what is it used for?

A rhizotomy is used for conditions that do not respond well to treatments such as physical therapy or medication. [1] Nerves work like cables that carry electrical signals between the brain and the body. [1] By damaging the specific nerves that send pain signals or trigger abnormal muscle tightness, healthcare providers can quiet the pathways responsible for the problem. [1]

Method	Description	Primary Use Case
Surgical Cutting	Nerve fibers are cut with a surgical instrument, using open surgery or a small endoscopic incision.	Selective dorsal rhizotomy for spasticity.
Chemical Ablation	A substance such as glycerin or glycerol is used to damage the nerve.	Trigeminal neuralgia and facial pain.
Radiofrequency Ablation	Focused high-intensity radio waves heat and damage the nerve.	Facet joint pain in the neck and back.

A nerve ablation and a rhizotomy have the same purpose. [1] “Rhizotomy” is the umbrella term, while radiofrequency ablation and chemical ablation are specific ways of damaging the nerve. Providers may also use the word “neurotomy.” You can read more about the heat-based method in our guide to radiofrequency ablation and about related approaches in our article on neurolysis for chronic pain management.

What conditions does rhizotomy treat?

Rhizotomies are named for the nerves they target and the conditions they treat. They are not a first-choice treatment. [1] Providers usually try more conservative options first, such as physical therapy, anti-inflammatory medicines, or nerve blocks. [1]

Rhizotomy Type	Target Area	Conditions Treated
Trigeminal Ganglion	Clusters of nerves (ganglia) on both sides of the face.	Trigeminal neuralgia, treatment-resistant cluster headaches, atypical face pain, and facial pain from postherpetic neuralgia or cancer.
Facet Rhizotomy	Nerves that travel through the facet joints of the spine.	Chronic neck or lower back pain from conditions such as arthritis and facet joint syndrome.
Selective Dorsal	Certain sensory nerve fibers in the lower spinal cord.	Spasticity in some children with cerebral palsy.

To learn more about the conditions behind these types of pain, see our guides to trigeminal neuralgia, facet arthropathy, lower back pain, and cervical spondylosis.

Illustration of a monitor in an operating room showing two nerve-signal waveforms, with surgical staff in scrubs and masks in the background. – rinnit.com — During a rhizotomy, electrical stimulation and monitoring help confirm that the correct nerve is being targeted.

How do you prepare for a rhizotomy, and how is it done?

Rhizotomy preparation often includes imaging, a nerve block and blood and urine tests, and the procedure usually uses anesthesia and imaging guidance to locate and destroy the nerve.

Before the procedure

Each type of rhizotomy has its own preparation, and your healthcare team will tell you what to do. Tests often include imaging such as an MRI or X-rays, a nerve block to locate the problem nerves, blood tests, and a urine test. [1] If you will have general anesthesia, you will meet an anesthesiologist first [1] (see our guide to anesthesia types, safety, and recovery). You may need to stop blood thinners [1], but never stop a medicine unless your provider tells you to.

During the procedure

Anesthesia or sedation: Most rhizotomies use general anesthesia. Others use sedation or a local anesthetic. [1]
Imaging guidance: Most rhizotomies use imaging, usually fluoroscopy, to locate the nerves and place the needle correctly. A contrast dye may be given through an IV. [1]
Nerve testing: The provider usually tests the nerve with electrical stimulation to confirm it is the right one to treat. [1]
Destroying the nerve: Depending on the type, the provider uses chemical ablation, radiofrequency ablation, or surgical cutting. [1]

Results, side effects, and recovery

Soreness, bruising, or minor bleeding at the injection or incision site is common, usually mild, and goes away within a few days. [1] Some side effects are expected for certain procedures, such as loss of facial sensation after a trigeminal rhizotomy. [1] In rare cases, an infection can develop at the site. [1]

Illustration of a figure walking and reaching out among soft green and blue trees, with a warm golden glow along the neck and spine. – rinnit.com — For many people, a successful rhizotomy means less pain and easier movement in daily life.

When to call your healthcare provider

Call your provider right away if you notice signs of a complication after the procedure, such as an infection at the incision site, or nerve problems such as weakness or burning pain. [1]

Conclusion

A rhizotomy can be a valuable option for people with debilitating chronic pain or spasticity that has not improved with other treatments. By targeting and disabling specific nerve pathways, it can reduce symptoms and improve function for many people, but results vary and not everyone benefits. Evidence is also stronger for some types and conditions than for others, so it is important to talk through the likely benefits and risks of your specific procedure with your care team.

What are the next steps if you are considering rhizotomy?

Considering rhizotomy starts with seeing a neurologist or pain specialist, completing diagnostic tests, reviewing rhizotomy types, preparing for recovery and tracking pain levels.

Consult a specialist: Speak with a neurologist or pain management specialist to see if you are a candidate.
Complete diagnostic testing: Have any recommended imaging or nerve blocks to identify the source of the pain.
Review your treatment options: Discuss the different types of rhizotomy and which one fits your situation.
Prepare for recovery: Ask your care team how much rest and follow-up you will need.
Track your progress: Keep a log of your pain levels before and after the procedure to share with your care team.

Trusted resources: Cleveland Clinic: Rhizotomy.

Frequently Asked Questions

What is the primary goal of a rhizotomy?

The goal is to relieve chronic pain or spasticity by damaging the nerves that send the problem signals, so those signals no longer reach the brain or muscles.

Is rhizotomy a permanent procedure?

The aim is lasting relief. Cutting nerves in selective dorsal rhizotomy is permanent, but after ablation procedures pain can return if the nerve regrows over time.

What is the difference between rhizotomy and ablation?

Rhizotomy is the umbrella term for damaging nerve fibers that cause pain or other problems. Ablation refers to specific methods, such as heat (radiofrequency) or chemicals, used to do it.

Who is a candidate for selective dorsal rhizotomy?

It is used for some children with cerebral palsy who have significant spasticity that interferes with movement. Not every child with cerebral palsy is a candidate, so a specialist team makes that decision.

How long does the relief last?

Most people who have a rhizotomy get long-lasting pain relief or a significant improvement in spasticity, but some get little to no relief. How long it lasts depends on the condition, the nerves treated, and the method used.

Is the procedure performed under general anesthesia?

Most rhizotomies use general anesthesia. Some types use sedation or a local anesthetic instead.

What are the common side effects?

Soreness, bruising, and minor bleeding at the injection or incision site are common and usually go away within a few days. Some procedures cause expected side effects, such as loss of facial sensation after a trigeminal rhizotomy.

Can rhizotomy treat back pain?

Facet rhizotomy is used for chronic neck or lower back pain from conditions such as arthritis and facet joint syndrome. Evidence is mixed, and a 2025 international guideline recommends against joint radiofrequency ablation for chronic spine pain, so discuss the options with your provider.

How long is the recovery period?

Recovery depends on the type of rhizotomy. Your healthcare team will tell you when you can return to your normal activities.

What tests are needed before the procedure?

Imaging tests such as an MRI or X-rays and a nerve block to locate the problem nerves are common. Blood and urine tests may also be done.

Are there risks of infection?

In rare cases, an infection can develop at the injection or incision site. Call your provider right away if you notice signs of infection.

Does rhizotomy affect muscle strength?

Selective dorsal rhizotomy targets sensory nerve fibers rather than motor nerves, and in a review of 16 studies of 756 children, gross motor function scores improved on average after surgery. Your team can explain the risks of weakness or numbness for your specific procedure.

Can it help with cluster headaches?

Trigeminal ganglion rhizotomy is sometimes used for chronic cluster headaches that do not respond to other treatments.

What happens if the procedure does not work?

If a rhizotomy gives no relief, your healthcare team will re-evaluate the source of the pain and consider other therapies.

Is it the first choice for chronic pain?

No. Providers usually try conservative treatments first, such as physical therapy, anti-inflammatory medicines, and nerve blocks.

References

Cleveland Clinic. Rhizotomy. Cleveland Clinic. April 14, 2023. https://my.clevelandclinic.org/health/treatments/24903-rhizotomy
Pereira MA, Soares VG, Faria HS, et al. Effectiveness of selective dorsal rhizotomy for spastic cerebral palsy: a systematic review and single-arm meta-analysis. J Neurosurg Sci. 2026;70(4):312-317. PMID 41920161. https://doi.org/10.23736/S0390-5616.26.06768-8
Láinez Ramos-Bossini AJ, Jiménez Gutiérrez PM, Ruiz Santiago F. Efficacy of radiofrequency in lumbar facet joint pain: a systematic review and meta-analysis of placebo-controlled randomized controlled trials. Radiol Med. 2024;129(5):794-806. PMID 38512629. https://doi.org/10.1007/s11547-024-01809-8
Busse JW, Genevay S, Agarwal A, et al. Commonly used interventional procedures for non-cancer chronic spine pain: a clinical practice guideline. BMJ. 2025;388:e079970. PMID 39971339. https://doi.org/10.1136/bmj-2024-079970

Medical disclaimer

This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.