Cutting or Destruction of Nervous Tissue
Surgical cutting or destruction of peripheral or central nervous tissue is now rarely used in the treatment of pain. Procedures include neurectomy, cordotomy, dorsal root entry zone lesioning, and cingulotomy.
Neurectomy involves cutting a nerve, and is (rarely) used in patients with short life expectancy who are unsuitable for drug therapy due to ineffectiveness or intolerance. The dorsal root or dorsal root ganglion (that carry mostly sensory signals) may be usefully targeted (called rhizotomy); with the dorsal root ganglion possibly the more effective target because some sensory fibers enter the spinal cord from the dorsal root ganglion via the ventral (motor) root, and these would not be interrupted by dorsal root neurectomy. Because nerves often carry both sensory and motor fibers, motor impairment is a possible side effect of neurectomy. A common result of this procedure is "deafferentation pain" where, 6–9 months after surgery, pain returns at greater intensity.
Cordotomy involves cutting into the spinothalamic tracts, which run up the front/side (anterolateral) quadrant of the spinal cord, carrying heat and pain signals to the brain (fig. 6). Pancoast tumor pain has been effectively treated with dorsal root entry zone (DREZ) lesioning – damaging a region of the spinal cord where peripheral pain signals cross to spinal cord fibers. This is major surgery, carrying the risk of significant neurological side effects. Cingulotomy involves cutting the fibers that carry signals directly from the cingulate gyrus to the entorhinal cortex in the brain. It reduces the unpleasantness of pain (without affecting its intensity), but may have cognitive side effects.
Read more about this topic: Interventional Pain Medicine
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