Sensory ganglionectomy: theory, technical aspects, and clinical experience

Abstract

Object. Sensory ganglionectomy offers theoretical advantages over rhizotomy but remains controversial because reported success rates vary widely. The authors sought to add to the available data on this subject and to review technical aspects of the surgery. Methods. This retrospective chart review included 19 patients, in whom 22 operations were performed and 35 sensory ganglia were resected between May 1995 and May 1999. The eight women and 11 men ranged in age from 27 to 75 years (median age 40 years, average age 42.3 years). All patients had undergone extensive therapy and a mean of 2.4 previous operations (median three, range zero—eight operations) for their pain, all without long-term pain relief. Duration of symptoms varied, from 1 month (for the cancer patient) to 15 years (mean 5.9, median 4 years). Preoperatively, all patients underwent diagnostic selective nerve root blocks, which temporarily relieved their targeted pain. The duration of follow up averaged 22 months (median 13, range 1.5 [to death of the cancer patient]—58 months). Before undergoing the first ganglionectomy, nearly all patients rated their targeted pain as 8 to 10 (average 9.6, median 10) on an analog (0–10) pain scale. At 6 months all patients rated their ganglionectomy-specific pain as an average of 4.5 (median 4, range 0–8), and pain reduction of 50% or more was achieved in 74%. At 1 year or more the 13 patients available for study rated their pain as an average of 4.3 (median 4.5, range 0–9). There were no severe complications, residual pain was never worse than presurgical pain, and no patient experienced significant or lasting new motor deficits. Conclusions. Dorsal root ganglionectomy has a useful role in the treatment of a variety of refractory pain states, especially those involving radicular pain.