Modified open thoracic rhizotomy for treatment of intractable chest wall pain of malignant etiology.

We describe the surgical technique of modified open thoracic rhizotomy for treatment of intractable chest wall pain of malignant etiology. In a series of 14 patients, 9 (64%) had an excellent result, 4 (29%) had a good result, and 1 (7%) had a poor result. Successful palliation was made possible by identification with computed tomographic scan or magnetic resonance imaging of the nerve roots involved. Pain control lasted in most patients until death (median, 22 weeks; range, 6 to 45 weeks). The extrathecal procedure described has certain advantages over intradural transection of nerve roots. Indications for performing this procedure are discussed along with other therapeutic options.