Introduction: Occipital neuralgia (ON) causes chronic pain in the cutaneous distribution of the greater and lesser occipital nerves. In medically refractory ON patients, the efficacy of dorsal root rhizotomy (DRX) for long term pain relief and functional outcomes has only been evaluated in small numbers. We reviewed our fourteen year experience with DRX for medically refractory ON.
Methods: Retrospective chart review of 55 ON patients, who met established diagnostic criteria, had positive responses to CT-guided nerve blocks and underwent DRX, was performed. Telephone interviews were used to assess patient satisfaction.
Results: Mean age at surgery was 46 years (range 16-80 years) and females comprised 76% of the sample. Average follow-up was 67 months (4.6-150 months). Etiologies included: idiopathic (42%), post-traumatic (27%), post-surgical (22%), post-cerebrovascular accident (5%), post-herpetic (2%) and post-viral (2%) (Table 1). At follow-up, 35 (64%) patients achieved full pain relief, 11 (20%) obtained partial relief and 7 (16%) patients reported no pain relief. A Chi-square analysis revealed no significant (p-value>0.05) association between ON etiology and extent of pain relief after DRX. Out of 37 subjects evaluated for satisfaction, 25 (68%) endorsed that they would undergo this surgery again, if needed, as they found it worthwhile/beneficial, 11 (30%) did not and 1 (2%) remained unsure. 21 (57%) subjects found that their activity level/functional state improved after surgery, five (13%) reported a decline and eleven (30%) recalled no change. The most common acute post-operative complications were wound infections (8.8%) and CSF leaks (5.3%); chronic complications included neck pain/stiffness (15.8%) and upper extremity symptoms (7.0%) such as trapezius weakness, shoulder pain and arm paresthesias.
Conclusions: Dorsal root rhizotomy provides a viable, safe and long term solution for pain relief for medically refractory ON. Future prospective trials with adequate follow-up and comparison with other interventions are needed to determine optimal management of ON patients.
Patient Care: These findings highlight the role and utility of dorsal root rhizotomy in patients suffering from refractory occipital neuralgia. Our extensive experience with and long term outcomes after this surgery signifies the high probability of DRX providing lasting pain relief to ON patients, with minimal complications.
Learning Objectives: 1) Describe the long-term efficacies (pain-relief, satisfaction, etc.) of dorsal root rhizotomy in addressing medically refractory occipital neuralgia 2) Identify the acute and long-term complications associated with intradural rhizotomy of the upper cervical dorsal roots 3)Discuss potential future studies regarding optimal management of patients suffering from refractory occipital neuralgia