title: Long-term outcomes of intradural cervical dorsal root rhizotomy for refractory occipital neuralgia.
abstract: OBJECT Occipital neuralgia (ON) causes chronic pain in the cutaneous distribution of the greater and lesser occipital nerves. The long-term efficacy of cervical dorsal root rhizotomy (CDR) in the management of ON has not been well described. The authors reviewed their 14-year experience with CDR to assess pain relief and functional outcomes in patients with medically refractory ON. METHODS A retrospective chart review of 75 ON patients who underwent cervical dorsal root rhizotomy, from 1998 to 2012, was performed. Fifty-five patients were included because they met the International Headache Society's (IHS) diagnostic criteria for ON, responded to CT-guided nerve blocks at the C-2 dorsal nerve root, and had at least one follow-up visit. Telephone interviews were additionally used to obtain data on patient satisfaction. RESULTS Forty-two patients (76%) were female, and the average age at surgery was 46 years (range 16-80). Average follow up was 67 months (range 5-150). Etiologies of ON included the following: idiopathic (44%), posttraumatic (27%), postsurgical (22%), post-cerebrovascular accident (4%), postherpetic (2%), and postviral (2%). At last follow-up, 35 patients (64%) reported full pain relief, 11 (20%) partial relief, and 7 (16%) no pain relief. The extent of pain relief after CDR was not significantly associated with ON etiology (p = 0.43). Of 37 patients whose satisfaction-related data were obtained, 25 (68%) reported willingness to undergo repeat surgery for similar pain relief, while 11 (30%) reported no such willingness; a single patient (2%) did not answer this question. Twenty-one individuals (57%) reported that their activity level/functional state improved after surgery, 5 (13%) reported a decline, and 11 (30%) reported no difference. The most common acute postoperative complications were infections in 9% (n = 5) and CSF leaks in 5% (n = 3); chronic complications included neck pain/stiffness in 16% (n = 9) and upper-extremity symptoms in 5% (n = 3) such as trapezius weakness, shoulder pain, and arm paresthesias. CONCLUSIONS Cervical dorsal root rhizotomy provides an efficacious means for pain relief in patients with medically refractory ON. In the appropriately selected patient, it may lead to optimal outcomes with a relatively low risk of complications.
authors.affiliation: University of Pittsburgh School of Medicine;
authors.forename: Abhiram V
authors.initials: AV
authors.lastname: Gande
authors.affiliation: University of Pittsburgh School of Medicine;
authors.forename: Srinivas
authors.initials: S
authors.lastname: Chivukula
authors.affiliation: Departments of 2 Neurological Surgery and.
authors.forename: John J
authors.initials: JJ
authors.lastname: Moossy
authors.affiliation: Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: William
authors.initials: W
authors.lastname: Rothfus
authors.affiliation: Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Vikas
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: Departments of 2 Neurological Surgery and.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Horowitz
authors.affiliation: Departments of 2 Neurological Surgery and.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gardner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000601:surgery*; D010147:Pain Measurement; D020127:Recovery of Function; D012189:Retrospective Studies; D019051:Rhizotomy; D013126:Spinal Nerve Roots / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: CDR = cervical dorsal root rhizotomy; CVA = cerebrovascular accident; ON = occipital neuralgia; RFA = radiofrequency ablation; TN = trigeminal neuralgia; dorsal; nerve root; occipital neuralgia; outcomes; pain; rhizotomy