Efficacy of Spinal Radicular Block and Facet Rhizotomy for Pain Associated with Metastatic Tumor of the Spine

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• Patients with metastatic tumor of the spine present with intense backache or intense pain radiating to the trunks or limbs, and the daily activities of these patients are markedly impaired because physical movements commonly aggravate the pain. The mechanism of backache is thought to be the excessive weight bearing on the facet joints caused by the instability of the spine. Therefore, blockage of the medial braches of the posterior ramus should be useful in the relief of backache. The source of the radiating pain is thought to be the compression of nerve roots by the collapsed vertebrae, and thus, radicular blockage should be useful in the relief of radicular pain.Thirty-one patients (24 males and 7 females, mean age 60.5 years, range 45-77 year) with metastatic tumor of the spine were studied. Neural blocks were used to treat backache in 27 of the patients and radicular pain in 24 of the patients. Infiltrating blocks of the medial branches with local anesthetics relieved backache in 18 (67%) of the 27 patients for an average duration of 6.4 days. Percutaneous thermocoagulation of the medial branches (facet rhizotomy) provided relief in 24 (89%) of the 27 patients for an average duration of 14.7 weeks. Root blocks with local anesthetics relieved radicular pain in 14 (58%) of the 24 patients for an average duration of 10 weeks, and percutaneous thermocoagulation of the nerve roots (spinal rhizotomy) provided relief in 6 (75%) of the 8 patients for an average duration of 6.7 weeks. Improvement of daily activities was observed in 87% of all patients and in 8 of the 23 in-patients discharged from the hospital. There were no serious complications except slight motor weakness after spinal rhizotomy in 2 patients.A medial branch block and a radicular block, including a facet rhizotomy and a spinal rhizotomy, were safer and easier to perform as repeat procedures than were intrathecal neurolytic block or percutaneous cordotomy for the reduction of pain due to metastatic tumor of the spine. Orthostatic jackets and other devices that stabilize the spine are necessary during the follow-up period because nerve blocks can provide pain relief but cannot stabilize the destroyed spine.

• 一般社団法人 日本ペインクリニック学会の論文

一般社団法人 日本ペインクリニック学会 | 論文

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