Dorsal root ganglionectomy for failed back surgery syndrome: a 5-year follow-up study

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✓ Dorsal root ganglionectomy has been suggested as a method for the treatment of chronic intractable radicular pain, with theoretical advantages over dorsal rhizotomy, which does not interrupt ventral root afferents. The indications for these procedures in patients with persistent pain following lumbosacral spine surgery are not well established. Long-term results have been reported infrequently, and no published series has a mean follow-up period of more than 30 months.

The authors have reviewed their experience with a series of 13 patients with failed back surgery syndrome, in whom dorsal root ganglionectomy was performed. Patients were selected on the basis of clinical presentation and diagnostic root blocks suggesting a monoradicular pain syndrome. Follow-up data were obtained at a mean of 5.5 years following dorsal root ganglionectomy. Follow-up interviews to assess outcome were conducted by a disinterested third party. Treatment “success” (at least 50% sustained relief of pain and patient satisfaction with the result) was recorded in two patients at 2 years after surgery and in none at 5.5 years. Equivocal success (at least 50% relief, without clearcut patient satisfaction) was recorded in one patient at 2 and at 5.5 years postoperatively. Improvements in activities of daily living were recorded in a minority of patients. Loss of sensory and motor function was reported frequently by patients. A minority of patients had reduced or eliminated analgesic intake. These results suggest that dorsal root ganglionectomy has a limited role in the management of failed back surgery syndrome, and that methods to select patients to receive this procedure should be refined or alternative approaches should be considered.

Article Information

Address reprint requests to: Richard B. North, M.D., Department of Neurosurgery, Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 7–113, Baltimore, Maryland 21205.

© AANS, except where prohibited by US copyright law.

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    Summary of outcome in 12 patients with dorsal root ganglionectomy for failed back surgery syndrome with a mean follow-up period of 5.5 years. After dorsal root ganglionectomy, patients' reported impairment in activities of daily living due to pain was for the most part unchanged. Improvement was reported much more often than increased impairment, however. The intake of analgesic medications was reduced in most cases. Neurological function (motor, sensory, bowel/bladder) often worsened; even after a one-level ganglionectomy, most patients noted sensory loss.

References

  • 1.

    Abbe R: Intradural section of the spinal nerves for neuralgia. Bost Med Surg J 135:3293351896Abbe R: Intradural section of the spinal nerves for neuralgia. Bost Med Surg J 135:329–335 1896

    • Search Google Scholar
    • Export Citation
  • 2.

    Basbaum AIWall PD: Chronic changes in the response of cells in adult cat dorsal horn following partial deafferentation: the appearance of responding cells in a previously non-responsive region. Brain Res 116:1812041976Basbaum AI Wall PD: Chronic changes in the response of cells in adult cat dorsal horn following partial deafferentation: the appearance of responding cells in a previously non-responsive region. Brain Res 116:181–204 1976

    • Search Google Scholar
    • Export Citation
  • 3.

    Bell C: Idea of a New Anatomy of the Brain. London: Strahan & Preston1811 pp 1719Bell C: Idea of a New Anatomy of the Brain. London: Strahan & Preston 1811 pp 17–19

    • Search Google Scholar
    • Export Citation
  • 4.

    Bernard C: Leçons sur la Physiologie et la Pathologie du Systeme Nerveux. Paris: Bailliere et Fils1858 pp 20112Bernard C: Leçons sur la Physiologie et la Pathologie du Systeme Nerveux. Paris: Bailliere et Fils 1858 pp 20–112

    • Search Google Scholar
    • Export Citation
  • 5.

    Campbell JN: Examination of possible mechanisms by which stimulation of the spinal cord in man relieves pain. Appl Neurophysiol 44:1811861981Campbell JN: Examination of possible mechanisms by which stimulation of the spinal cord in man relieves pain. Appl Neurophysiol 44:181–186 1981

    • Search Google Scholar
    • Export Citation
  • 6.

    Campbell JNDavis KDMeyer RAet al: The mechanism by which dorsal column stimulation affects pain: evidence for a new hypothesis. Pain 5 (Suppl):2281990 (Abstract)Campbell JN Davis KD Meyer RA et al: The mechanism by which dorsal column stimulation affects pain: evidence for a new hypothesis. Pain 5 (Suppl):228 1990 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 7.

    Campbell JNRaja SNMeyer RAet al: Myelinated afferents signal the hyperalgesia associated with nerve injury. Pain 32:89941988Campbell JN Raja SN Meyer RA et al: Myelinated afferents signal the hyperalgesia associated with nerve injury. Pain 32:89–94 1988

    • Search Google Scholar
    • Export Citation
  • 8.

    Clifton GLVance WHApplebaum MLet al: Responses of unmyelinated afTerents in the mammalian ventral root. Brain Res 57:1631671974Clifton GL Vance WH Applebaum ML et al: Responses of unmyelinated afTerents in the mammalian ventral root. Brain Res 57:163–167 1974

    • Search Google Scholar
    • Export Citation
  • 9.

    Coggeshall RE: Afferent fibers in the ventral root. Neurosurgery 4:4434481979Coggeshall RE: Afferent fibers in the ventral root. Neurosurgery 4:443–448 1979

    • Search Google Scholar
    • Export Citation
  • 10.

    Coggeshall REApplebaum MLFazen Met al: Unmyelinated axons in human ventral roots, a possible explanation for the failure of dorsal rhizotomy to relieve pain. Brain 98:1571661975Coggeshall RE Applebaum ML Fazen M et al: Unmyelinated axons in human ventral roots a possible explanation for the failure of dorsal rhizotomy to relieve pain. Brain 98:157–166 1975

    • Search Google Scholar
    • Export Citation
  • 11.

    Coggeshall RECoulter JDWillis WD: Unmyelinated axons in the ventral roots of the cat lumbosacral enlargement. J Comp Neurol 153:39581974Coggeshall RE Coulter JD Willis WD: Unmyelinated axons in the ventral roots of the cat lumbosacral enlargement. J Comp Neurol 153:39–58 1974

    • Search Google Scholar
    • Export Citation
  • 12.

    Coggeshall RECoulter JDWillis WD: Unmyelinated fibers in the ventral root. J Cell Biol 55:47a1972 (Abstract)Coggeshall RE Coulter JD Willis WD: Unmyelinated fibers in the ventral root. J Cell Biol 55:47a 1972 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 13.

    Coggeshall REIto H: Sensory fibers in ventral roots L7 and S, in the cat. J Physiol (Lond) 267:2152351977Coggeshall RE Ito H: Sensory fibers in ventral roots L7 and S in the cat. J Physiol (Lond) 267:215–235 1977

    • Search Google Scholar
    • Export Citation
  • 14.

    Denny-Brown DKirk EJ: Hyperesthesia from spinal and root lesions. Trans Am Neurol Assoc 93:1161201968Denny-Brown D Kirk EJ: Hyperesthesia from spinal and root lesions. Trans Am Neurol Assoc 93:116–120 1968

    • Search Google Scholar
    • Export Citation
  • 15.

    Dimsdale JAKemp JM: Afferent fibres in the ventral nerve roots in the rat. J Physiol 187:25261966Dimsdale JA Kemp JM: Afferent fibres in the ventral nerve roots in the rat. J Physiol 187:25–26 1966

    • Search Google Scholar
    • Export Citation
  • 16.

    Echols DH: Sensory rhizotomy following operation for ruptured intervertebral disc. A review of 62 cases. J Neurosurg 31:3353381969Echols DH: Sensory rhizotomy following operation for ruptured intervertebral disc. A review of 62 cases. J Neurosurg 31:335–338 1969

    • Search Google Scholar
    • Export Citation
  • 17.

    Erickson DLLong DM: Ten-year follow-up of dorsal column stimulation in Bonica JJLindblom UIggo A (eds): Advances in Pain Research and Therapy Vol 5. Proceedings of the Third World Congress on Pain. New York: Raven Press1983 pp 583589Erickson DL Long DM: Ten-year follow-up of dorsal column stimulation in Bonica JJ Lindblom U Iggo A (eds): Advances in Pain Research and Therapy Vol 5. Proceedings of the Third World Congress on Pain. New York: Raven Press 1983 pp 583–589

    • Search Google Scholar
    • Export Citation
  • 18.

    Foerster OAltenburger HKroll FW: Über die Beziehungen des vegetativen Nervensystems zur Sensibilitat. Z Neurol Psych 121:1391851929Foerster O Altenburger H Kroll FW: Über die Beziehungen des vegetativen Nervensystems zur Sensibilitat. Z Neurol Psych 121:139–185 1929

    • Search Google Scholar
    • Export Citation
  • 19.

    Freud S: Über Spinalgnaglien und Ruckenmark des Petromyzon. Sitzungsb Akad Wissensch 78:811671879Freud S: Über Spinalgnaglien und Ruckenmark des Petromyzon. Sitzungsb Akad Wissensch 78:81–167 1879

    • Search Google Scholar
    • Export Citation
  • 20.

    Frykholm RHyde JNorlen Get al: On pain sensations produced by stimulation of ventral roots in man. Acta Physiol Scand (Suppl) 160:4554691953Frykholm R Hyde J Norlen G et al: On pain sensations produced by stimulation of ventral roots in man. Acta Physiol Scand (Suppl) 160:455–469 1953

    • Search Google Scholar
    • Export Citation
  • 21.

    Groves EWH: On the division of the posterior spinal roots: (1) for pain, (2) for visceral crises, (3) for spasm. Lancet 2:79851911Groves EWH: On the division of the posterior spinal roots: (1) for pain (2) for visceral crises (3) for spasm. Lancet 2:79–85 1911

    • Search Google Scholar
    • Export Citation
  • 22.

    Hoppenstein R: A new approach to the failed back syndrome. Spine 5:3713791980Hoppenstein R: A new approach to the failed back syndrome. Spine 5:371–379 1980

    • Search Google Scholar
    • Export Citation
  • 23.

    Hosobuchi Y: The majority of unmyelinated afferent axons in human ventral roots probably conduct pain. Pain 8:1671801980Hosobuchi Y: The majority of unmyelinated afferent axons in human ventral roots probably conduct pain. Pain 8:167–180 1980

    • Search Google Scholar
    • Export Citation
  • 24.

    Howe JFLoeser JDCalvin WH: Mechanosensitivity of dorsal root ganglia and chronically injured axons: a physiological basis for the radicular pain of nerve root compression. Pain 3:25411977Howe JF Loeser JD Calvin WH: Mechanosensitivity of dorsal root ganglia and chronically injured axons: a physiological basis for the radicular pain of nerve root compression. Pain 3:25–41 1977

    • Search Google Scholar
    • Export Citation
  • 25.

    Jacob MWeddell G: Neural intersegmental connection in the spinal root and ganglion region of the rat. J Comp Neurol 161:1151241975Jacob M Weddell G: Neural intersegmental connection in the spinal root and ganglion region of the rat. J Comp Neurol 161:115–124 1975

    • Search Google Scholar
    • Export Citation
  • 26.

    Jensen MPKaroly PBraver S: The measurement of clinical pain intensity: a comparison of six methods. Pain 27:1171261986Jensen MP Karoly P Braver S: The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126 1986

    • Search Google Scholar
    • Export Citation
  • 27.

    Kato MHirata Y: Sensory neurons in the spinal ventral roots of the cat. Brain Res 7:4794821968Kato M Hirata Y: Sensory neurons in the spinal ventral roots of the cat. Brain Res 7:479–482 1968

    • Search Google Scholar
    • Export Citation
  • 28.

    Kerr FWL: Central nervous system changes and deafferentation pain: the role of reorganization and gliosis in Bonica JJLindblom UIggo A (eds): Advances in Pain Research Therapy Vol 5. Proceedings of the Third World Congress of Pain. New York: Raven Press1983 pp 663675Kerr FWL: Central nervous system changes and deafferentation pain: the role of reorganization and gliosis in Bonica JJ Lindblom U Iggo A (eds): Advances in Pain Research Therapy Vol 5. Proceedings of the Third World Congress of Pain. New York: Raven Press 1983 pp 663–675

    • Search Google Scholar
    • Export Citation
  • 29.

    Kibler RFNathan PW: Relief of pain and paresthesiae by nerve block distal to a lesion. J Neurol Neurosurg Psychiatry 23:91981960Kibler RF Nathan PW: Relief of pain and paresthesiae by nerve block distal to a lesion. J Neurol Neurosurg Psychiatry 23:91–98 1960

    • Search Google Scholar
    • Export Citation
  • 30.

    Knapp RCBoston M: Division of the posterior spinal roots for amputation neuralgia. Bost Med Surg J 158:1491511908Knapp RC Boston M: Division of the posterior spinal roots for amputation neuralgia. Bost Med Surg J 158:149–151 1908

    • Search Google Scholar
    • Export Citation
  • 31.

    Law LDLehman RAWKirsch WM: Reoperation after lumbar intervertebral disc surgery. J Neurosurg 48:2592631978Law LD Lehman RAW Kirsch WM: Reoperation after lumbar intervertebral disc surgery. J Neurosurg 48:259–263 1978

    • Search Google Scholar
    • Export Citation
  • 32.

    Lehmann W: Über die sensiblen Fasern der vorderen Worzeln. Klin Wochenschr 3:189518981924Lehmann W: Über die sensiblen Fasern der vorderen Worzeln. Klin Wochenschr 3:1895–1898 1924

    • Search Google Scholar
    • Export Citation
  • 33.

    Lenz FAKwan HCDostrovsky JOet al: Characteristics of the bursting pattern of action potentials that occurs in the thalamus of patients with central pain. Brain Res 496:3573601989Lenz FA Kwan HC Dostrovsky JO et al: Characteristics of the bursting pattern of action potentials that occurs in the thalamus of patients with central pain. Brain Res 496:357–360 1989

    • Search Google Scholar
    • Export Citation
  • 34.

    Light ARMetz CB: The morphology of the spinal cord efferent and afferent neurons contributing to the ventral roots of the cat. J Comp Neurol 179:5015161978Light AR Metz CB: The morphology of the spinal cord efferent and afferent neurons contributing to the ventral roots of the cat. J Comp Neurol 179:501–516 1978

    • Search Google Scholar
    • Export Citation
  • 35.

    Liu CNChambers WW: Intraspinal sprouting of dorsal root axons. Arch Neurol Psychiatry 79:46611958Liu CN Chambers WW: Intraspinal sprouting of dorsal root axons. Arch Neurol Psychiatry 79:46–61 1958

    • Search Google Scholar
    • Export Citation
  • 36.

    Loeser JD: Dorsal rhizotomy for the relief of chronic pain. J Neurosurg 36:7457501972Loeser JD: Dorsal rhizotomy for the relief of chronic pain. J Neurosurg 36:745–750 1972

    • Search Google Scholar
    • Export Citation
  • 37.

    Loeser JDWard AA Jr: Some effects of deafferentation on neurons of the cat spinal cord. Arch Neurol 17:6296361967Loeser JD Ward AA Jr: Some effects of deafferentation on neurons of the cat spinal cord. Arch Neurol 17:629–636 1967

    • Search Google Scholar
    • Export Citation
  • 38.

    Lombard MCBesson JM: Attempts to gauge the relative importance of pre- and postsynaptic effects of morphine on the transmission of noxious messages in the dorsal horn of the rat spinal cord. Pain 37:3353451989Lombard MC Besson JM: Attempts to gauge the relative importance of pre- and postsynaptic effects of morphine on the transmission of noxious messages in the dorsal horn of the rat spinal cord. Pain 37:335–345 1989

    • Search Google Scholar
    • Export Citation
  • 39.

    Long DMErickson DE: Stimulation of the posterior columns of the spinal cord for relief of intractable pain. Surg Neurol 4:1341411975Long DM Erickson DE: Stimulation of the posterior columns of the spinal cord for relief of intractable pain. Surg Neurol 4:134–141 1975

    • Search Google Scholar
    • Export Citation
  • 40.

    Magendie F: Expériences sur les fonctions des racines des nerfs qui naissent de la moëlle épenière. J Physiol Exp 2:3663711822Magendie F: Expériences sur les fonctions des racines des nerfs qui naissent de la moëlle épenière. J Physiol Exp 2:366–371 1822

    • Search Google Scholar
    • Export Citation
  • 41.

    Maynard CWLeonard RBCoulter JDet al: Central connections of ventral root afferents as demonstrated by the HRP method. J Comp Neurol 172:6016081977Maynard CW Leonard RB Coulter JD et al: Central connections of ventral root afferents as demonstrated by the HRP method. J Comp Neurol 172:601–608 1977

    • Search Google Scholar
    • Export Citation
  • 42.

    Melzack R: The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:2772991975Melzack R: The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:277–299 1975

    • Search Google Scholar
    • Export Citation
  • 43.

    Miller JBasbaum AIWall PD: Restructuring of the somatotopic map and appearance of abnormal neuronal activity in the gracile nucleus after partial deafferentation. Exp Neurol 50:6586721976Miller J Basbaum AI Wall PD: Restructuring of the somatotopic map and appearance of abnormal neuronal activity in the gracile nucleus after partial deafferentation. Exp Neurol 50:658–672 1976

    • Search Google Scholar
    • Export Citation
  • 44.

    Nash TP: Percutaneous radiofrequency lesioning of dorsal root ganglia for intractable pain. Pain 24:67731986Nash TP: Percutaneous radiofrequency lesioning of dorsal root ganglia for intractable pain. Pain 24:67–73 1986

    • Search Google Scholar
    • Export Citation
  • 45.

    North RBEwend MGLawton MTet al: Spinal cord stimulation for intractable pain: superiority of “multichannel” devices. Pain (In press 1990)North RB Ewend MG Lawton MT et al: Spinal cord stimulation for intractable pain: superiority of “multichannel” devices. Pain (In press 1990)

    • Search Google Scholar
    • Export Citation
  • 46.

    Ochoa JLTorebjörk HE: Pain from skin and muscle. Pain (Suppl) 1:871981 (Abstract)Ochoa JL Torebjörk HE: Pain from skin and muscle. Pain (Suppl) 1:87 1981 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 47.

    Onofrio BMCampa HK: Evaluation of rhizotomy. Review of 12 years' experience. J Neurosurg 36:7517551972Onofrio BM Campa HK: Evaluation of rhizotomy. Review of 12 years' experience. J Neurosurg 36:751–755 1972

    • Search Google Scholar
    • Export Citation
  • 48.

    Osgood CPDujovny MFaille Ret al: Microsurgical ganglionectomy for chronic pain syndromes. Technical note. J Neurosurg 45:1131151976Osgood CP Dujovny M Faille R et al: Microsurgical ganglionectomy for chronic pain syndromes. Technical note. J Neurosurg 45:113–115 1976

    • Search Google Scholar
    • Export Citation
  • 49.

    Pallie W: The intersegmental anastomoses of posterior spinal rootlets and their significance. J Neurosurg 16:1881961959Pallie W: The intersegmental anastomoses of posterior spinal rootlets and their significance. J Neurosurg 16:188–196 1959

    • Search Google Scholar
    • Export Citation
  • 50.

    Pawl RP: Microsurgical ganglionectomy for treatment of arachnoiditis-related unilateral sciatica. Presented to the American Pain Society, Miami1982 (Cited in Gybels JM Sweet WH: Neurosurgical Treatment of Persistent Pain. New York: Karger 1989 p 122)Pawl RP: Microsurgical ganglionectomy for treatment of arachnoiditis-related unilateral sciatica. Presented to the American Pain Society Miami 1982 (Cited in Gybels JM Sweet WH: Neurosurgical Treatment of Persistent Pain. New York: Karger 1989 p 122)

  • 51.

    Ray BS: The management of intractable pain by posterior rhizotomy. Res Publ Assoc Res Nerv Ment Dis 23:3914071943Ray BS: The management of intractable pain by posterior rhizotomy. Res Publ Assoc Res Nerv Ment Dis 23:391–407 1943

    • Search Google Scholar
    • Export Citation
  • 52.

    Scoville WB: Extradural spinal sensory rhizotomy. J Neurosurg 25:94951966Scoville WB: Extradural spinal sensory rhizotomy. J Neurosurg 25:94–95 1966

    • Search Google Scholar
    • Export Citation
  • 53.

    Sherrington CS: On the anatomical constitution of nerves of skeletal muscles; with remarks on recurrent fibres in the ventral spinal nerve root. J Physiol (Lond) 17:2112581894Sherrington CS: On the anatomical constitution of nerves of skeletal muscles; with remarks on recurrent fibres in the ventral spinal nerve root. J Physiol (Lond) 17:211–258 1894

    • Search Google Scholar
    • Export Citation
  • 54.

    Smith FP: Trans-spinal ganglionectomy for relief of intercostal pain. J Neurosurg 32:5745771970Smith FP: Trans-spinal ganglionectomy for relief of intercostal pain. J Neurosurg 32:574–577 1970

    • Search Google Scholar
    • Export Citation
  • 55.

    Stacey MJ: Free nerve endings in skeletal muscle of the cat. J Anat 105:2312541969Stacey MJ: Free nerve endings in skeletal muscle of the cat. J Anat 105:231–254 1969

    • Search Google Scholar
    • Export Citation
  • 56.

    Strait TAHunter SE: Intraspinal extradural sensory rhizotomy in patients with failure of lumbar disc surgery. J Neurosurg 54:1931961981Strait TA Hunter SE: Intraspinal extradural sensory rhizotomy in patients with failure of lumbar disc surgery. J Neurosurg 54:193–196 1981

    • Search Google Scholar
    • Export Citation
  • 57.

    Tasker RR: Deafferentation in Wall PDMelzack R (eds): Textbook of Pain. Edinburgh: Churchill-Livingston1984 pp 119132Tasker RR: Deafferentation in Wall PD Melzack R (eds): Textbook of Pain. Edinburgh: Churchill-Livingston 1984 pp 119–132

    • Search Google Scholar
    • Export Citation
  • 58.

    Taub A: Ganglionectomy lectures presented to the Massachusetts General Hospital 1985 (Cited in Gybels JM Sweet WH: Neurosurgical Treatment of Persistent Pain. New York: Karger 1989 p 123)Taub A: Ganglionectomy lectures presented to the Massachusetts General Hospital 1985 (Cited in Gybels JM Sweet WH: Neurosurgical Treatment of Persistent Pain. New York: Karger 1989 p 123)

  • 59.

    Taub A: Relief of chronic intractable sciatica by dorsal root ganglionectomy. Trans Am Neurol Assoc 105:3403431980Taub A: Relief of chronic intractable sciatica by dorsal root ganglionectomy. Trans Am Neurol Assoc 105:340–343 1980

    • Search Google Scholar
    • Export Citation
  • 60.

    Taub A: Suppression of post-ganglionectomy dysesthesia by systemic lidocaine. Presented to the American Pain Society, Washington, DC1986 (Cited in Gybels JM Sweet WH: Neurosurgical Treatment of Persistent Pain. New York: Karger 1989 p 123)Taub A: Suppression of post-ganglionectomy dysesthesia by systemic lidocaine. Presented to the American Pain Society Washington DC 1986 (Cited in Gybels JM Sweet WH: Neurosurgical Treatment of Persistent Pain. New York: Karger 1989 p 123)

  • 61.

    Torebjörk HESchady WOchoa J: Sensory correlates of somatic afferent fibre activation. Hum Neurobiol 3:15201984Torebjörk HE Schady W Ochoa J: Sensory correlates of somatic afferent fibre activation. Hum Neurobiol 3:15–20 1984

    • Search Google Scholar
    • Export Citation
  • 62.

    Wall PDDevor M: Sensory afferent impulses originate from dorsal root ganglia as well as from the periphery in normal and nerve injured rats. Pain 17:3213391983Wall PD Devor M: Sensory afferent impulses originate from dorsal root ganglia as well as from the periphery in normal and nerve injured rats. Pain 17:321–339 1983

    • Search Google Scholar
    • Export Citation
  • 63.

    Wall PDGutnick M: Ongoing activity in peripheral nerves: the physiology and pharmacology of impulses originating from a neuroma. Exp Neurol 43:5805931974Wall PD Gutnick M: Ongoing activity in peripheral nerves: the physiology and pharmacology of impulses originating from a neuroma. Exp Neurol 43:580–593 1974

    • Search Google Scholar
    • Export Citation
  • 64.

    Webber RHWemett A: Distribition of fibers from nerve cell bodies in ventral spinal nerves. Acta Anat 65:5795831966Webber RH Wemett A: Distribition of fibers from nerve cell bodies in ventral spinal nerves. Acta Anat 65:579–583 1966

    • Search Google Scholar
    • Export Citation
  • 65.

    Weddell GGuttmann LGuttmann E: Local extension of nerve fibers into denervated areas of skin. J Neurol Neurosurg Psychiatry 4:2062241941Weddell G Guttmann L Guttmann E: Local extension of nerve fibers into denervated areas of skin. J Neurol Neurosurg Psychiatry 4:206–224 1941

    • Search Google Scholar
    • Export Citation
  • 66.

    White JCKjellberg RN: Posterior spinal rhizotomy. A substitute for cordotomy in the relief of localized pain in patients with normal life expectancy. Neurochirurgia 16:1411701973White JC Kjellberg RN: Posterior spinal rhizotomy. A substitute for cordotomy in the relief of localized pain in patients with normal life expectancy. Neurochirurgia 16:141–170 1973

    • Search Google Scholar
    • Export Citation
  • 67.

    White JCSweet WH: Pain and the Neurosurgeon: A Forty-Year Experience. Springfield, Ill: Charles C Thomas19691000 ppWhite JC Sweet WH: Pain and the Neurosurgeon: A Forty-Year Experience. Springfield Ill: Charles C Thomas 1969 1000 pp

    • Search Google Scholar
    • Export Citation
  • 68.

    Windle WF: Neurons of the sensory type in the ventral roots of man and other mammals. Arch Neurol Psychiatry 26:7918001931Windle WF: Neurons of the sensory type in the ventral roots of man and other mammals. Arch Neurol Psychiatry 26:791–800 1931

    • Search Google Scholar
    • Export Citation
  • 69.

    Xavier AVMcDanal JKissin I: Relief of sciatic radicular pain by sciatic nerve block. Anestli Analg 67:117711801988Xavier AV McDanal J Kissin I: Relief of sciatic radicular pain by sciatic nerve block. Anestli Analg 67:1177–1180 1988

    • Search Google Scholar
    • Export Citation
  • 70.

    Yamamoto TTakahashi KSatomi Het al: Origins of primary afferent fibers in the ventral spinal roots in the cat as demonstrated by the horseradish peroxidase method. Brain Res 126:3503541977Yamamoto T Takahashi K Satomi H et al: Origins of primary afferent fibers in the ventral spinal roots in the cat as demonstrated by the horseradish peroxidase method. Brain Res 126:350–354 1977

    • Search Google Scholar
    • Export Citation
  • 71.

    Young RF: Dorsal rhizotomy and dorsal root ganglionectomy in Youmans JR (ed): Neurological Surgeryed 3. Philadelphia: WB Saunders1990 Vol 6 pp 40264035Young RF: Dorsal rhizotomy and dorsal root ganglionectomy in Youmans JR (ed): Neurological Surgery ed 3. Philadelphia: WB Saunders 1990 Vol 6 pp 4026–4035

    • Search Google Scholar
    • Export Citation

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