Dorsal Rhizotomy and Dorsal Root Ganglionectomy

Abstract

Pain surgery is one of the challenging fields of neurological surgery. This chapter presents a review of probably old notions in surgical pain management, with their indications, surgical techniques, and outcomes. Dorsal root ganglionectomy and dorsal rhizotomy engage problems of cancer pain and noncancer pain. Because contemporary procedures such as neuromodulation techniques and intrathecal opiates take an active role in this century, dorsal rhizotomy, dorsal root ganglionectomy, and neurotomy have been almost abandoned. However, destructive surgical procedures still have an essential role in the treatment of specific pain syndromes. Therefore the indications for destructive procedures and technical skills to perform these procedures still should be known by pain surgeons. Here we present the indications about the described procedures: For cervical dorsal rhizotomy and ganglionectomy:• Cancerous pain such as malignancies involving brachial plexus and noncancerous pain • Concancerous pain such as occipital neuralgia For thoracic rhizotomy and ganglionectomy: • Malignancies of the thorax and the chest wall • İatrogenic allodynia related to toracotomy or laporotomy • Bilateral refractory intercostal neuralgia following augmentation mammoplasty For lumbosacral ganglionectomy and sacral rhizotomy: •Pelvic neoplasm •İntolerable neurogenic bladder •Management of spasticity Other remaining indications: •Diffuse paraplegic spasticity in patients with cerebral palsy •Posttraumatic spastic diplegia © 2023 Elsevier Inc. All rights reserved.