Management of chronic severe pain: Spinal neuromodulatory and neuroablative approaches

Research output: Chapter in Book/Report/Conference proceedingChapter

31 Scopus citations


The spinal cord is the target of many neurosurgical procedures used to treat pain. Compactness and well-defined tract separation in addition to well understood dermatomal cord organization make the spinal cord an ideal target for pain procedures. Moreover, the presence of opioid and other receptors involved in pain modulation at the level of the dorsal horn increases the suitability of the spinal cord. Neuromodulative approaches of the spinal cord are either electrical or pharmacological. Electrical spinal cord modulation is used on a large scale for various pain syndromes including; failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), neuropathic pain, angina, and ischemic limb pain. Intraspinal delivery of medications e.g. opioids is used to treat nociceptive and neuropathic pains due to malignant and cancer pain etiologies. Neuroablation of the spinal cord pain pathway is mainly used to treat cancer pain. Targets involved include; the spinothalamic tract, the midline dorsal column visceral pain pathway and the trigeminal tract in the upper spinal cord. Spinal neuroablation can also involve cellular elements such as with trigeminal nucleotomy and the dorsal root entry zone (DREZ) operation. The DREZ operation is indicated for phantom type pain and root avulsion injuries. Due to its reversible nature spinal neuromodulation prevails, and spinal neuroablation is performed in a few select cases.

Original languageEnglish (US)
Title of host publicationOperative Neuromodulation
Subtitle of host publicationVolume 1: Functional Neuroprosthetic Surgery. An Introduction
PublisherSpringer Wien
Number of pages9
Edition97 PART 1
ISBN (Print)9783211330784
StatePublished - 2007

Publication series

NameActa Neurochirurgica, Supplementum
Number97 PART 1
ISSN (Print)0065-1419


  • Neuromodulation
  • chronic pain
  • neuroablation
  • spinal
  • treatment

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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