The treatment of chronic thoracic segmental pain by radiofrequency percutaneous partial rhizotomy

View More View Less
  • 1 Pain Clinic, University Hospital, and Department of Functional Anatomy, Rudolf Magnus Institute for Neurosciences, Utrecht University, Utrecht, The Netherlands; and Pain Clinic Rodenkirchen, Cologne, Germany
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ Forty-five patients, 12 men and 33 women with an age range of 17 to 88 years (median 52 years), were selected for a posterior thoracic percutaneous partial rhizotomy (PPR) based on the following criteria. Each patient had at least a 6-month history of irradiating pain that followed the segmental pattern of an intercostal nerve and had not responded to conservative treatment. In addition, no causal treatment was available and there was a temporary positive response to an intercostal blockade with lidocaine.

In the lower thoracic region (T8–12) PPR was performed with the usual dorsolateral technique; in the upper thoracic region a dorsal approach was used by means of a drill hole made with a Kirschner wire in the vertebral arch. The 45 patients underwent 53 thoracic PPR operations. Patients were evaluated 2 months after treatment. Thirty patients (66.7%) were pain-free: in 11 cases (24.4%) more than 50% improvement was achieved, and in four (8.9%) there was no improvement. Side effects consisting of a transient burning pain or a mild transient sensory loss occurred in eight patients (17.7%). After a follow-up period of 13 to 46 months (median 24 months) results were evaluated in 41 patients; five patients had undergone reintervention. Excellent long-term results were achieved in 20 patients (48.8%), good results in 15 (36.6%), and poor results in six (14.6%).

It is concluded, that when conservative treatment fails, thoracic PPR may prove an effective and safe treatment for chronic segmental thoracic pain.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Robert J. Stolker, M.D., Department of Functional Anatomy, Utrecht University, Stratenum Building, P.O. Box 80039, 3508 TA Utrecht, The Netherlands.
  • 1.

    Arbit E, , Galichich JH, & Burt M, et al: Modified open thoracic rhizotomy for treatment of intractable chest wall pain of malignant etiology. Ann Thorac Surg 48:820823, 1989 Arbit E, Galichich JH, Burt M, et al: Modified open thoracic rhizotomy for treatment of intractable chest wall pain of malignant etiology. Ann Thorac Surg 48:820–823, 1989

    • Search Google Scholar
    • Export Citation
  • 2.

    Bogduk N, , Macintosh J, & Marsland A: Technical limitations to the efficacy of radiofrequency neurotomy for spinal pain. Neurosurgery 20:529535, 1987 Bogduk N, Macintosh J, Marsland A: Technical limitations to the efficacy of radiofrequency neurotomy for spinal pain. Neurosurgery 20:529–535, 1987

    • Search Google Scholar
    • Export Citation
  • 3.

    Bonica JJ: The Management of Pain. Philadelphia: Lea & Febiger, 1991, pp 11141145 Bonica JJ: The Management of Pain. Philadelphia: Lea & Febiger, 1991, pp 1114–1145

    • Search Google Scholar
    • Export Citation
  • 4.

    Coggeshall 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 98:157166, 1975 Coggeshall 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
  • 5.

    Cosman ER, & Cosman BJ: Methods of making nervous system lesions, in Wilkins RH, & Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill, 1985, pp 24902499 Cosman ER, Cosman BJ: Methods of making nervous system lesions, in Wilkins RH, Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill, 1985, pp 2490–2499

    • Search Google Scholar
    • Export Citation
  • 6.

    Cosman ER, , Nashold BS, & Ovelman-Levitt J: Theoretical aspects of radiofrequency lesions in the dorsal root entry zone. Neurosurgery 15:945950, 1984 Cosman ER, Nashold BS, Ovelman-Levitt J: Theoretical aspects of radiofrequency lesions in the dorsal root entry zone. Neurosurgery 15:945–950, 1984

    • Search Google Scholar
    • Export Citation
  • 7.

    Dajczman E, , Gordon A, & Kreisman H, et al: Long-term post-thoracotomy pain. Chest 99:270274, 1991 Dajczman E, Gordon A, Kreisman H, et al: Long-term post-thoracotomy pain. Chest 99:270–274, 1991

    • Search Google Scholar
    • Export Citation
  • 8.

    Dubuisson D: Root surgery, in Wall PD, & Melzack R (eds): Textbook of Pain. Edinburgh: Churchill Livingstone, 1989, pp 784794 Dubuisson D: Root surgery, in Wall PD, Melzack R (eds): Textbook of Pain. Edinburgh: Churchill Livingstone, 1989, pp 784–794

    • Search Google Scholar
    • Export Citation
  • 9.

    Echols DH: The effectiveness of thoracic rhizotomy for chronic pain. Neurochirurgia 13:6974, 1970 Echols DH: The effectiveness of thoracic rhizotomy for chronic pain. Neurochirurgia 13:69–74, 1970

    • Search Google Scholar
    • Export Citation
  • 10.

    Foerster O: The dermatomes in man. Brain 56:139, 1933 Foerster O: The dermatomes in man. Brain 56:1–39, 1933

  • 11.

    Garcia Cosamalòn PJ, , Mostaza A, & Fernandez J, et al: Dorsal percutaneous radiofrequency rhizotomy guided with CT scan in intercostal neuralgias. Technical note. Acta Neurochir 109:140141, 1991 Garcia Cosamalòn PJ, Mostaza A, Fernandez J, et al: Dorsal percutaneous radiofrequency rhizotomy guided with CT scan in intercostal neuralgias. Technical note. Acta Neurochir 109:140–141, 1991

    • Search Google Scholar
    • Export Citation
  • 12.

    Groen GJ, , Baljet B, & Drukker J: The innervation of the spinal dura mater: anatomy and clinical implications. Acta Neurochir 92:3946, 1988 Groen GJ, Baljet B, Drukker J: The innervation of the spinal dura mater: anatomy and clinical implications. Acta Neurochir 92:39–46, 1988

    • Search Google Scholar
    • Export Citation
  • 13.

    Groen GJ, , Stolker RJ, & Vervest ACM: Anatomische Grundlagen destruktiver Eingriffe. Der Schmerz 6:S5, 1992 Groen GJ, Stolker RJ, Vervest ACM: Anatomische Grundlagen destruktiver Eingriffe. Der Schmerz 6:S5, 1992

    • Search Google Scholar
    • Export Citation
  • 4.

    Gybels JM, & Sweet WH: Neurosurgical Treatment of Persistent Pain. Physiological and Pathological Mechanisms of Human Pain. Basel: Karger, 1989, pp 1069 Gybels JM, Sweet WH: Neurosurgical Treatment of Persistent Pain. Physiological and Pathological Mechanisms of Human Pain. Basel: Karger, 1989, pp 10–69

    • Search Google Scholar
    • Export Citation
  • 15.

    Katz J: Cryoanalgesia for postthoracotomy pain. Ann Thorac Surg 48:5, 1989 (Editorial) Katz J: Cryoanalgesia for postthoracotomy pain. Ann Thorac Surg 48:5, 1989 (Editorial)

    • Search Google Scholar
    • Export Citation
  • 16.

    Koning HM, , Koster HG, & Niemeijer RPE: Ischaemic spinal cord lesion following percutaneous radiofrequency spinal rhizotomy. Pain 45:161166, 1991 Koning HM, Koster HG, Niemeijer RPE: Ischaemic spinal cord lesion following percutaneous radiofrequency spinal rhizotomy. Pain 45:161–166, 1991

    • Search Google Scholar
    • Export Citation
  • 17.

    Lazorthes Y, , Verdie JC, & Lagarrigue J: Thermocoagulation percutanée des nerfs rachidiens à visée analgésique. Neurochirurgie 22:445453, 1976 Lazorthes Y, Verdie JC, Lagarrigue J: Thermocoagulation percutanée des nerfs rachidiens à visée analgésique. Neurochirurgie 22:445–453, 1976

    • Search Google Scholar
    • Export Citation
  • 18.

    Letcher FS, & Goldring S: The effect of radiofrequency current and heat on peripheral nerve action potential in the cat. J Neurosurg 29:4247, 1968 Letcher FS, Goldring S: The effect of radiofrequency current and heat on peripheral nerve action potential in the cat. J Neurosurg 29:42–47, 1968

    • Search Google Scholar
    • Export Citation
  • 19.

    Loeser JD: Definition, etiology, and neurological assessment of pain originating in the nervous system following deafferentation. Adv Pain Res Ther 5:701711, 1983 Loeser JD: Definition, etiology, and neurological assessment of pain originating in the nervous system following deafferentation. Adv Pain Res Ther 5:701–711, 1983

    • Search Google Scholar
    • Export Citation
  • 20.

    Loeser JD: Dorsal rhizotomy for the relief of chronic pain. J Neurosurg 36:745750, 1972 Loeser JD: Dorsal rhizotomy for the relief of chronic pain. J Neurosurg 36:745–750, 1972

    • Search Google Scholar
    • Export Citation
  • 21.

    MacDonagh RP, , Forster DMC, & Thomas DG: Urinary continence in spinal injury patients following complete sacral posterior rhizotomy. Br J Urol 66:618622, 1990 MacDonagh RP, Forster DMC, Thomas DG: Urinary continence in spinal injury patients following complete sacral posterior rhizotomy. Br J Urol 66:618–622, 1990

    • Search Google Scholar
    • Export Citation
  • 22.

    Moringlane JR, , Koch R, & Schäfer H, et al: Experimental radiofrequency (RF) coagulation with computer-based on line monitoring of temperature and power. Acta Neurochir 96:126131, 1989 Moringlane JR, Koch R, Schäfer H, et al: Experimental radiofrequency (RF) coagulation with computer-based on line monitoring of temperature and power. Acta Neurochir 96:126–131, 1989

    • Search Google Scholar
    • Export Citation
  • 23.

    Nash TP: Percutaneous radiofrequency lesioning of dorsal root ganglia for intractable pain. Pain 24:6773, 1986 Nash TP: Percutaneous radiofrequency lesioning of dorsal root ganglia for intractable pain. Pain 24:67–73, 1986

    • Search Google Scholar
    • Export Citation
  • 24.

    Niv D, & Chayen MS: Reduction of localised cancer pain by percutaneous dorsal root ganglia lesions. Pain Clin 5:229234, 1992 Niv D, Chayen MS: Reduction of localised cancer pain by percutaneous dorsal root ganglia lesions. Pain Clin 5:229–234, 1992

    • Search Google Scholar
    • Export Citation
  • 25.

    North RB, , Kidd DH, & Campbell JN, et al: Dorsal root ganglionectomy for failed back surgery syndrome: a 5-year follow-up study. J Neurosurg 74:236242, 1991 North RB, Kidd DH, Campbell JN, et al: Dorsal root ganglionectomy for failed back surgery syndrome: a 5-year follow-up study. J Neurosurg 74:236–242, 1991

    • Search Google Scholar
    • Export Citation
  • 26.

    Onofrio BM, & Campa HK: Evaluation of rhizotomy. Review of 12 years' experience. J Neurosurg 36:751755, 1972 Onofrio BM, Campa HK: Evaluation of rhizotomy. Review of 12 years' experience. J Neurosurg 36:751–755, 1972

    • Search Google Scholar
    • Export Citation
  • 27.

    Oppenheim WL: Selective posterior rhizotomy for spastic cerebral palsy. A review. Clin Orthop 253:2029, 1990 Oppenheim WL: Selective posterior rhizotomy for spastic cerebral palsy. A review. Clin Orthop 253:20–29, 1990

    • Search Google Scholar
    • Export Citation
  • 28.

    Osgood CP, , Dujovny M, & Faille R, et al: Microsurgical ganglionectomy for chronic pain syndromes. Technical note. J Neurosurg 45:113115, 1976 Osgood 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
  • 29.

    Ovelmen-Levitt J, , Johnson B, & Bedenbaugh P, et al: Dorsal root rhizotomy and avulsion in the cat: a comparison of long term effects on dorsal horn neuronal activity. Neurosurgery 15:921927, 1984 Ovelmen-Levitt J, Johnson B, Bedenbaugh P, et al: Dorsal root rhizotomy and avulsion in the cat: a comparison of long term effects on dorsal horn neuronal activity. Neurosurgery 15:921–927, 1984

    • Search Google Scholar
    • Export Citation
  • 30.

    Pagura JR: Percutaneous radiofrequency spinal rhizotomy. Appl Neurophysiol 46:138146, 1983 Pagura JR: Percutaneous radiofrequency spinal rhizotomy. Appl Neurophysiol 46:138–146, 1983

    • Search Google Scholar
    • Export Citation
  • 31.

    Pallie W: The intersegmental anastomoses of posterior spinal rootlets and their significance. J Neurosurg 16:188196, 1959 Pallie W: The intersegmental anastomoses of posterior spinal rootlets and their significance. J Neurosurg 16:188–196, 1959

    • Search Google Scholar
    • Export Citation
  • 32.

    Peters J, , Large RG, & Elkind G: Follow-up results from a randomised controlled trial evaluating in- and outpatient pain management programmes. Pain 50:4150, 1992 Peters J, Large RG, Elkind G: Follow-up results from a randomised controlled trial evaluating in- and outpatient pain management programmes. Pain 50:41–50, 1992

    • Search Google Scholar
    • Export Citation
  • 33.

    Piscol K: Die Blutversorgung des Rückenmarkes und ihre klinische Relevanz. Schriftenreihe Neurologie. Band 8. Berlin: Springer-Verlag, 1972, pp 2157 Piscol K: Die Blutversorgung des Rückenmarkes und ihre klinische Relevanz. Schriftenreihe Neurologie. Band 8. Berlin: Springer-Verlag, 1972, pp 21–57

    • Search Google Scholar
    • Export Citation
  • 34.

    Purcell-Jones G, , Speedy HM, & Justins DM: Upper limb sympathetic blockade following intercostal nerve blocks. Anaesthesia 42:984986, 1987 Purcell-Jones G, Speedy HM, Justins DM: Upper limb sympathetic blockade following intercostal nerve blocks. Anaesthesia 42:984–986, 1987

    • Search Google Scholar
    • Export Citation
  • 35.

    Sindou M, & Goutelle A: Surgical posterior rhizotomies for the treatment of pain. Adv Tech Stand Neurosurg 10:147185, 1983 Sindou M, Goutelle A: Surgical posterior rhizotomies for the treatment of pain. Adv Tech Stand Neurosurg 10:147–185, 1983

    • Search Google Scholar
    • Export Citation
  • 36.

    Sluijter ME, & Mehta M: Treatment of chronic back and neck pain by percutaneous thermal lesions, in Lipton S, & Miles JK (eds): Persistent Pain: Modern Methods of Treatment. London: Academic Press, 1981, Vol 3, pp 141179 Sluijter ME, Mehta M: Treatment of chronic back and neck pain by percutaneous thermal lesions, in Lipton S, Miles JK (eds): Persistent Pain: Modern Methods of Treatment. London: Academic Press, 1981, Vol 3, pp 141–179

    • Search Google Scholar
    • Export Citation
  • 37.

    Smith FP: Trans-spinal ganglionectomy for relief of intercostal pain. J Neurosurg 32:574577, 1970 Smith FP: Trans-spinal ganglionectomy for relief of intercostal pain. J Neurosurg 32:574–577, 1970

    • Search Google Scholar
    • Export Citation
  • 38.

    Smith HP, , McWhorter JM, & Challa VR: Radiofrequency neurolysis in a clinical model. Neuropathological correlation. J Neurosurg 55:246253, 1981 Smith HP, McWhorter JM, Challa VR: Radiofrequency neurolysis in a clinical model. Neuropathological correlation. J Neurosurg 55:246–253, 1981

    • Search Google Scholar
    • Export Citation
  • 39.

    Sweet WH: Deafferentation pain after posterior rhizotomy, trauma to a limb, and herpes zoster. Neurosurgery 15:928932, 1984 Sweet WH: Deafferentation pain after posterior rhizotomy, trauma to a limb, and herpes zoster. Neurosurgery 15:928–932, 1984

    • Search Google Scholar
    • Export Citation
  • 40.

    Sweet WH, & Wepsic JG: Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. Part 1: Trigeminal neuralgia. J Neurosurg 39:143156, 1974 Sweet WH, Wepsic JG: Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. Part 1: Trigeminal neuralgia. J Neurosurg 39:143–156, 1974

    • Search Google Scholar
    • Export Citation
  • 41.

    Uematsu S: Percutaneous electrothermocoagulation of spinal nerve trunk, ganglion, and rootlets, in Schmidek HH, & Sweet WH (eds): Operative Neurosurgical Techniques: Indications, Methods, and Results. New York: Grune & Stratton, 1982, pp 11771198 Uematsu S: Percutaneous electrothermocoagulation of spinal nerve trunk, ganglion, and rootlets, in Schmidek HH, Sweet WH (eds): Operative Neurosurgical Techniques: Indications, Methods, and Results. New York: Grune & Stratton, 1982, pp 1177–1198

    • Search Google Scholar
    • Export Citation
  • 42.

    Uematsu S, , Udvarhelyi GB, & Benson DW, et al: Percutaneous radiofrequency rhizotomy. Surg Neurol 2:319325, 1974 Uematsu S, Udvarhelyi GB, Benson DW, et al: Percutaneous radiofrequency rhizotomy. Surg Neurol 2:319–325, 1974

    • Search Google Scholar
    • Export Citation
  • 43.

    van Kleef M, , Spaans F, & Dingemans W, et al: Effects and side effects of a percutaneous thermal lesion of the dorsal root ganglion in patients with cervical pain syndrome. Pain 52:4953, 1993 van Kleef M, Spaans F, Dingemans W, et al: Effects and side effects of a percutaneous thermal lesion of the dorsal root ganglion in patients with cervical pain syndrome. Pain 52:49–53, 1993

    • Search Google Scholar
    • Export Citation
  • 44.

    Verdie JC, & Lazorthes Y: Thermocoagulation percutanáe analgésique des racines rachidiennes. Nouv Presse Méd 11:21312134, 1982 Verdie JC, Lazorthes Y: Thermocoagulation percutanáe analgésique des racines rachidiennes. Nouv Presse Méd 11:2131–2134, 1982

    • Search Google Scholar
    • Export Citation
  • 45.

    Vervest ACM, & Stolker RJ: The treatment of cervical pain syndromes with radiofrequency procedures. Pain Clin 4:103112, 1991 Vervest ACM, Stolker RJ: The treatment of cervical pain syndromes with radiofrequency procedures. Pain Clin 4:103–112, 1991

    • Search Google Scholar
    • Export Citation
  • 46.

    Vervest ACM, , Stolker RJ, & Schimmel GH: Computerized data-acquisition and reports in the pain clinic. Pain Clin 6:8395, 1993 Vervest ACM, Stolker RJ, Schimmel GH: Computerized data-acquisition and reports in the pain clinic. Pain Clin 6:83–95, 1993

    • Search Google Scholar
    • Export Citation
  • 47.

    Wall PD: The placebo effect, an unpopular topic. Pain 51:13, 1992 (Editorial) Wall PD: The placebo effect, an unpopular topic. Pain 51:1–3, 1992 (Editorial)

    • Search Google Scholar
    • Export Citation
  • 48.

    Weinstein JN: Anatomy and neurophysiologic mechanisms of spinal pain, in Frymoyer JW (ed): The Adult Spine. Principles and Practice. New York: Raven Press, 1991, pp 593610 Weinstein JN: Anatomy and neurophysiologic mechanisms of spinal pain, in Frymoyer JW (ed): The Adult Spine. Principles and Practice. New York: Raven Press, 1991, pp 593–610

    • Search Google Scholar
    • Export Citation
  • 49.

    White JC, & Kjellberg RN: Posterior spinal rhizotomy: a substitute for cordotomy in the relief of localized pain in patients with normal life-expectancy. Neurochirurgia 16:141170, 1973 White 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
  • 50.

    Wood KM: Peripheral nerve and root chemical lesions, in Wall PD, & Melzack R (eds): Textbook of Pain. Edinburgh: Churchill Livingstone, 1989, pp 768772 Wood KM: Peripheral nerve and root chemical lesions, in Wall PD, Melzack R (eds): Textbook of Pain. Edinburgh: Churchill Livingstone, 1989, pp 768–772

    • Search Google Scholar
    • Export Citation
  • 51.

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

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 319 176 12
Full Text Views 174 16 0
PDF Downloads 93 15 0
EPUB Downloads 0 0 0