Abstract
Object. Nonmalignant pain has been treated in the past century with ablative, or more appropriately, destructive procedures. Although individual outcomes for these procedures have previously been described in the literature, to the authors' knowledge this is the first comprehensive and systematic review on this topic. Methods. A US National Library of Medicine PubMed search was conducted for the following ablative procedures: cingulotomy, cordotomy, DREZ (also input as dorsal root entry zone), ganglionectomy, mesencephalotomy, myelotomy, neurotomy, rhizotomy, sympathectomy, thalamotomy, and tractotomy. Articles related to pain resulting from malignancy and those not in peer-reviewed journals were excluded. In reviewing pertinent articles, focus was placed on patient number, outcome, and follow-up. Results. A total of 146 articles was included in the review. The large majority of studies (131) constituted Class III evidence. Eleven Class I and 4 Class II studies were found, of which nearly all (13 of 15) evaluated radiofrequency rhizotomies for different pain origins, including lumbar facet syndrome, cervical facet pain, and Type I or typical trigeminal neuralgia. Overall, support for ablative procedures for nonmalignant pain is derived almost entirely from Class III evidence; despite a long history of use in neurosurgery, the evidence supporting destructive procedures for benign pain conditions remains limited. Conclusions. Newly designed prospective standardized studies are required to define surgical indications and outcomes for these procedures, to provide more systematic review, and to advance the field.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 389-404 |
| Number of pages | 16 |
| Journal | Journal of Neurosurgery |
| Volume | 109 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 2008 |
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Keywords
- Ablation
- Cingulotomy
- Cordotomy
- Dorsal root entry zone
- Ganglionectomy
- Mesencephalotomy
- Myelotomy
- Neurotomy
- Pain surgery
- Rhizotomy
- Sympathectomy
- Thalamotomy
- Tractotomy
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
Destructive procedures for the treatment of nonmalignant pain : A structured literature review. / Cetas, Justin; Saedi, Targol; Burchiel, Kim.
In: Journal of Neurosurgery, Vol. 109, No. 3, 09.2008, p. 389-404.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Destructive procedures for the treatment of nonmalignant pain
T2 - A structured literature review
AU - Cetas, Justin
AU - Saedi, Targol
AU - Burchiel, Kim
PY - 2008/9
Y1 - 2008/9
N2 - Object. Nonmalignant pain has been treated in the past century with ablative, or more appropriately, destructive procedures. Although individual outcomes for these procedures have previously been described in the literature, to the authors' knowledge this is the first comprehensive and systematic review on this topic. Methods. A US National Library of Medicine PubMed search was conducted for the following ablative procedures: cingulotomy, cordotomy, DREZ (also input as dorsal root entry zone), ganglionectomy, mesencephalotomy, myelotomy, neurotomy, rhizotomy, sympathectomy, thalamotomy, and tractotomy. Articles related to pain resulting from malignancy and those not in peer-reviewed journals were excluded. In reviewing pertinent articles, focus was placed on patient number, outcome, and follow-up. Results. A total of 146 articles was included in the review. The large majority of studies (131) constituted Class III evidence. Eleven Class I and 4 Class II studies were found, of which nearly all (13 of 15) evaluated radiofrequency rhizotomies for different pain origins, including lumbar facet syndrome, cervical facet pain, and Type I or typical trigeminal neuralgia. Overall, support for ablative procedures for nonmalignant pain is derived almost entirely from Class III evidence; despite a long history of use in neurosurgery, the evidence supporting destructive procedures for benign pain conditions remains limited. Conclusions. Newly designed prospective standardized studies are required to define surgical indications and outcomes for these procedures, to provide more systematic review, and to advance the field.
AB - Object. Nonmalignant pain has been treated in the past century with ablative, or more appropriately, destructive procedures. Although individual outcomes for these procedures have previously been described in the literature, to the authors' knowledge this is the first comprehensive and systematic review on this topic. Methods. A US National Library of Medicine PubMed search was conducted for the following ablative procedures: cingulotomy, cordotomy, DREZ (also input as dorsal root entry zone), ganglionectomy, mesencephalotomy, myelotomy, neurotomy, rhizotomy, sympathectomy, thalamotomy, and tractotomy. Articles related to pain resulting from malignancy and those not in peer-reviewed journals were excluded. In reviewing pertinent articles, focus was placed on patient number, outcome, and follow-up. Results. A total of 146 articles was included in the review. The large majority of studies (131) constituted Class III evidence. Eleven Class I and 4 Class II studies were found, of which nearly all (13 of 15) evaluated radiofrequency rhizotomies for different pain origins, including lumbar facet syndrome, cervical facet pain, and Type I or typical trigeminal neuralgia. Overall, support for ablative procedures for nonmalignant pain is derived almost entirely from Class III evidence; despite a long history of use in neurosurgery, the evidence supporting destructive procedures for benign pain conditions remains limited. Conclusions. Newly designed prospective standardized studies are required to define surgical indications and outcomes for these procedures, to provide more systematic review, and to advance the field.
KW - Ablation
KW - Cingulotomy
KW - Cordotomy
KW - Dorsal root entry zone
KW - Ganglionectomy
KW - Mesencephalotomy
KW - Myelotomy
KW - Neurotomy
KW - Pain surgery
KW - Rhizotomy
KW - Sympathectomy
KW - Thalamotomy
KW - Tractotomy
UR - http://www.scopus.com/inward/record.url?scp=53449092248&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=53449092248&partnerID=8YFLogxK
U2 - 10.3171/JNS/2008/109/9/0389
DO - 10.3171/JNS/2008/109/9/0389
M3 - Article
VL - 109
SP - 389
EP - 404
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
SN - 0022-3085
IS - 3
ER -