Thoracic ganglionectomy: A rescue technique for failed dorsal root ganglion stimulation

Abstract

Dorsal root ganglion (DRG) stimulation emerged as an effective treatment for various forms of refractory chronic pain, although the evidence for thoracic neuropathic pain is scarce. Pain relief can decrease over time and might be underappreciated in clinical studies. Hence, alternative procedures should be kept in mind when DRG stimulation fails to provide lasting pain relief. A 55-year-old man had a 3-year history of severe right-sided refractory intercostal neuralgia after thoracic trauma (visual analogue scale (VAS) 6/10 for average intensity of pain) concerning T10 and T11 with allodynia. He underwent DRG stimulation, providing initial improvement (VAS 4/10). After two years, the relief had diminished (VAS 6/10), and a salvage ganglionectomy was performed (VAS 4/10). Seven months later DRG trial stimulation was performed for new pain at T9. Since no pain relief was achieved, a ganglionectomy at T9 was performed with subsequent removal of the stimulation system. At the last follow-up 3 years after the initial presentation, the patient reported continued pain relief (VAS 4/10) with absence of allodynia. Selective thoracic ganglionectomy is a viable rescue technique in patients with intercostal neuralgia in whom DRG stimulation fails to provide continuous pain relief.

Keywords

• Chronic pain
• Dorsal root ganglion stimulation
• Ganglionectomy