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Ousz and colleagues (2018) reported on the efficacy of posterior rhizotomy and DTNS in a series of 63 patients with neurogenic sciatalgia associated with SCT. All the cases were treated with a T8 level of sensory rhizotomy and an implantable intrathecal generator. We retrospectively compared the pre- and post-operative pain measures, quality of life, and sensory function between the patients with and without DTPNS. A total of 45 patients underwent DTPNS, whereas 18 patients had concurrent T8 sensory rhizotomy. Patients with DTPNS had an improvement in the Neuropathic Pain Scale, the McGill Pain Questionnaire, and the self-reported symptom of reflex sympathetic dystrophy when compared with patients who had sensory rhizotomy only. This difference was statistically significant. The total number of axons resected to achieve a DTPNS was significantly correlated with the changes in pain, quality of life, and reflex sympathetic dystrophy. Although sensory rhizotomy was associated with no change in limb numbness, weakness, and impaired joint mobility, DTPNS resulted in these changes in 40 % of patients. This study has shown that rhizotomy combined with DTPNS is associated with statistically significant improvement in neuropathic pain with no change in patient quality of life. The rate of sensory deficits after sensory rhizotomy is high.
In a retrospective case series, Morian and colleagues (2013) reported on the efficacy of cervical nerve root stimulation for the treatment of neuropathic pain associated with C5 radiculopathy. This study included 6 patients who were treated with electrical cervical nerve root stimulation over a 6-month period. Pain intensity was measured with a visual analog scale (VAS) prior to and at 3 and 6 months after the procedure. A total of 5.8 ± 1.2 hours were required to implant the device. There was a significant reduction in VAS scores from 6.8 ± 0.5 preoperatively to 2.8 ± 0.6 at 3-month follow-up and 2.4 ± 0.7 at 6-month follow-up. At 6-month follow-up, the average VAS score was less than 2 for all patients, and the scores were below the baseline scores in all patients.
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