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Management of chronic severe pain: spinal neuromodulatory and neuroablative approaches

  • Chapter
Operative Neuromodulation

Part of the book series: Acta Neurochirurgica Supplements ((NEUROCHIRURGICA,volume 97/1))

Summary

The spinal cord is the target of many neurosurgical procedures used to treat pain. Compactness and well-defined tract separation in addition to well understood dermatomal cord organization make the spinal cord an ideal target for pain procedures. Moreover, the presence of opioid and other receptors involved in pain modulation at the level of the dorsal horn increases the suitability of the spinal cord.

Neuromodulative approaches of the spinal cord are either electrical or pharmacological. Electrical spinal cord modulation is used on a large scale for various pain syndromes including; failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), neuropathic pain, angina, and ischemic limb pain. Intraspinal delivery of medications e.g. opioids is used to treat nociceptive and neuropathic pains due to malignant and cancer pain etiologies.

Neuroablation of the spinal cord pain pathway is mainly used to treat cancer pain. Targets involved include; the spinothalamic tract, the midline dorsal column visceral pain pathway and the trigeminal tract in the upper spinal cord. Spinal neuroablation can also involve cellular elements such as with trigeminal nucleotomy and the dorsal root entry zone (DREZ) operation. The DREZ operation is indicated for phantom type pain and root avulsion injuries.

Due to its reversible nature spinal neuromodulation prevails, and spinal neuroablation is performed in a few select cases.

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Authors and Affiliations

  1. Department of Neurological Surgery, L472 Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, 97239, USA

    Ahmed M. Raslan, S. McCartney & K. J. Burchiel

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  1. Ahmed M. Raslan
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  3. K. J. Burchiel
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Correspondence to Ahmed M. Raslan .

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Editors and Affiliations

  1. Department of Neurosurgery, University of Athens, Athens, Greece

    Damianos E. Sakas

  2. University Hospital of Wales, Cardiff, UK

    Brian A. Simpson

  3. Pacific Pain Treatment Centers, San Francisco, USA

    Elliot S. Krames

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Raslan, A.M., McCartney, S., Burchiel, K.J. (2007). Management of chronic severe pain: spinal neuromodulatory and neuroablative approaches. In: Sakas, D.E., Simpson, B.A., Krames, E.S. (eds) Operative Neuromodulation. Acta Neurochirurgica Supplements, vol 97/1. Springer, Vienna. https://doi.org/10.1007/978-3-211-33079-1_4

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