Sensory Ganglionectomy Versus Rhizotomy: Theory, Technical Aspects and Clinical Experience

Harold A. Wilkinson, MD
Andy S. Chan, MD

Objective:

Sensory ganglionectomy offers theoretical advantages over rhizotomy, but remains controversial. Reported success rates vary widely. We sought to add data on this subject and to review technical aspects of the surgery.

Methods:

This retrospective chart review included 19 patients (22 operations) with 35 sensory ganglia resected between May 1995 and May 1999. Eight females and 11 males ranged in age between 27 to 75 years (median 40, average 42.3). All patients had undergone extensive therapy and a mean of 2.4 (median 3, range 0 to 8) previous operations for their pain, all without long–term pain relief. Symptoms duration varied between 1 month (for the cancer patient) to 15 years (mean 5.9, median .4). Preoperatively all patients underwent diagnostic selective nerve root blocks which temporarily relieved their targeted pain. Follow–up averaged 22.2 months (median 13, range 1.5 –to death of the cancer patient to 58 months). Prior to first ganglionectomy all patients rated their targeted pain as '' 8–1 0,' (average "9.6" median "10") on an analogue (0–10) pain scale.

Results:

At 6–months all patients rated their ganglionectomy specific pain as an average of "4.5" (median "4", range "0.8"). At one year or more the 13 patients available 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 developed 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 neuropathic pain. Further studies are needed.