Other Spinal Surgeries

Sympathectomy

Sympathectomy is not recommended for pain following SCI (Nashold 1991). As mentioned previously, sympathetic blockade and sympathectomy have reportedly failed to relieve the central pain of SCI (Friedman & Nashold 1986; Melzack & Loeser 1978; White 1969).

Lateral Spinothalamic Tractotomy

Hazouri and Mueller (1950) described three selected cases of patients with intractable root pain, subsequent to severe trauma to the cauda equina which resulted in paraplegia (L2-4 lesions). All three patients demonstrated a distinct increase in the threshold for perception of pain and “an even more remarkable increase in the threshold for reaction to pain.” Lateral spinothalamic tractotomy in all three of these patients resulted in complete relief from pain. Threshold studies subsequent to the tractotomy “revealed a striking return of perception and reaction thresholds to a normal range.”

Spinal Cordotomy

This procedure can be performed openly or percutaneously. Anterior spinothalamic tracts subserving pain and temperature function are sectioned, often requiring a bilateral approach. Spinal cordotomy is an option but is rarely employed and there is little evidence that it works.