Neurectomy for Treatment of Intercostal Neuralgia

Background: Intercostal neuralgia due to surgical injury of the intercostal nerve is difficult to treat. No treatment modality has given effective pain relief. Experience with other painful neuromas has demonstrated that neuroma resection and muscle implantation has been effective in the upper and lower extremities. This approach was applied to patients with intercostal neuralgia. Methods: A retrospective review was done of 5 consecutive patients who have had neurectomy of one or more intercostal nerves. Preoperative and postoperative pain levels, patient demographics, length of follow-up, and surgical technique were reviewed. Results: Average patient age was 51.0 years (range, 39.2 to 61.3). Patients presented an average of 42.8 months (range, 10 to 138) after the surgical procedure or trauma that created their painful intercostal neuromas. The mean maximum pain level was 10, and the mean average pain level was 8 (range, 7 to 9). Postoperatively, the mean maximum pain level was 3.4 (range, 0 to 9), and the mean average pain level was 2.2 (range, 0 to 7). The differences were significant: p less than 0.01 for maximum pain level and p less than 0.05 for average pain level. Average follow-up after surgery was 8.8 months (range, 6.5 to 10.9). The most common surgical technique used was intercostal nerve neurectomy proximal to the intercostal nerve neuroma and implantation of the cut nerve into the latissimus dorsi muscle. Conclusions: Intercostal neurectomy and implantation of the cut nerve into the latissimus dorsi or into the rib for severe intercostal neuralgia was an efficacious treatment in this small consecutive patient series.