Pain Management

Dorsal Longitudinal T-Myelotomy for Pain Management Post-SCI

Author Year

Country
PEDro Score
Research Design
Total Sample Size

 Methods Outcome
Livshits et al. 2002

Germany/Israel

Case Control

N=40

 Population: Type of pain=neuropathic.

Treatment: Individuals with SCI underwent one of two different surgical procedures: longitudinal T-myelotomy using the Bishof II technique (n=20), or longitudinal myelotomy en croix (Pourpre procedure) (n=20).

Outcome Measures: Short form McGill Pain Questionnaire (SF-MPQ); Visual Analgoue Scale (VAS)

 1.     All individuals (regardless of surgical procedure) reported some pain relief.

2.     The Pourpre procedure appeared better than the Bischof II procedure at relieving pain, as measured by VAS and SF-MPQ (in the immediate and long term).

3.     By yr 5 and yr 10, individuals in both groups reported a return of motor spasticity.

Discussion

Dorsal longitudinal T-myelotomy is a surgery to treat severe spastic paraplegia but it has recently been studied for its effects on pain. Livshits et al. (2002) conducted a case control study comparing two approaches of dorsal longitudinal T-myelotomy (i.e., Pourpre vs. Bischof II) with respect to their effectiveness in reducing pain and spasticity in people with SCI, initially refractory to more conservative approaches (N=40). Systematic follow-up assessments at six months, five and ten years were conducted. In this study, significant pain reduction was obtained with either of these surgical techniques, as measured using scores obtained from the Short Form – McGill Pain Questionnaire (Short form McGill Pain Questionnaire), the Present Pain Intensity scale, and a visual analog scale, but this appeared to be more notable with the Pourpre versus the Bischof II procedure.

Conclusion

There is level 3 evidence (from one case control study: Livshits et al. 2002) to support the use of dorsal longitudinal T-myelotomy procedures, in particular Pourpre’s technique, to reduce spastic pain post SCI.

Dorsal longitudinal T-myelotomy procedures reduce pain post SCI.

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