Cutting or destruction of nervous tissue Interventional pain management

cross-section of spinal cord showing dorsal column , anterolateral spinothalamic tracts

surgical cutting or destruction of peripheral or central nervous tissue used in treatment of pain. procedures include neurectomy, cordotomy, dorsal root entry zone lesioning, , cingulotomy.

neurectomy involves cutting nerve, , (rarely) used in patients short life expectancy unsuitable drug therapy due ineffectiveness or intolerance. dorsal root or dorsal root ganglion (that carry sensory signals) may usefully targeted (called rhizotomy); dorsal root ganglion possibly more effective target because sensory fibers enter spinal cord dorsal root ganglion via ventral (motor) root, , these not interrupted dorsal root neurectomy. because nerves carry both sensory , motor fibers, motor impairment possible side effect of neurectomy. common result of procedure deafferentation pain where, 6–9 months after surgery, pain returns @ greater intensity.

cordotomy involves cutting spinothalamic tracts, run front/side (anterolateral) quadrant of spinal cord, carrying heat , pain signals brain.

pancoast tumor pain has been treated dorsal root entry zone (drez) lesioning – damaging region of spinal cord peripheral pain signals cross spinal cord fibers. major surgery, carrying risk of significant neurological side effects.

cingulotomy involves cutting fibers carry signals directly cingulate gyrus entorhinal cortex in brain. reduces unpleasantness of pain (without affecting intensity), may have cognitive side effects.