EXTRADURAL SENSORY RHIZOTOMY IN THE MANAGEMENT OF CHRONIC LUMBAR RADICULOPATHY - A MINIMUM 2-YEAR FOLLOW-UP-STUDY

Study Design. Fifty-one consecutive patients who underwent extradural sensory rhizotomy for chronic radiculopathy after lumbar surgery were reviewed retrospectively. Objectives. To determine the effectiveness o f sensory rhizotomy in the management of chronic radiculopathy in pati ents selected by extensive imaging techniques and selective nerve root sheath injections. Summary of Background Data. Results of more centra l ablative procedures for chronic benign pain problems have been disap pointing, with variable reports of pain relief. Methods. Fifty-one pat ients were reviewed. All patients underwent extensive evaluation to ex clude reversible structural lesions, and all had the diagnosis of chro nic radiculopathy confirmed by results of clinical and electrophysiolo gic examination. Selective nerve root sheath injections under fluorosc opic guidance confirmed the symptomatic nature of the segments. All bl ocks were repeated at least once. All patients underwent selective sen sory rhizotomy or, in some cases, complete rhizotomy. After rhizotomy, 37 patients were available to be observed at selected time intervals for a minimum of 2 years. Clinical results were determined by the pres ence or absence of pain relief (visual analog scale), sensory and moto r deficits, narcotic analgesic usage, and the patient's estimation of the effectiveness of the procedure. Results. At 6 months after surgery , all 51 patients and the outcomes of their surgery were available for review. Fifty-five percent of patients rated were believed to have go od or excellent outcomes, whereas the remainder had poor or failed out comes. For the minimum 2-year follow-up period (range, 2-4.2 years), 3 7 patients were available for review. Al final follow-up examination o nly 19% of the patients maintained good or excellent outcomes. Conclus ions. The results of the rhizotomy procedures deteriorated over time. Possible reasons for the failure, other than temporal deterioration, w ere anatomic factors and lack of specificity of diagnostic techniques, specifically selective nerve root sheath injection. At this point rhi zotomy cannot be recommended with any confidence whatsoever in the set ting of chronic lumbar radiculopathy after lumbar surgery.