Paraplegia after intercostal neurolysis with phenol

Area of Science:

• Oncology
• Pain Management
• Neurology

Background:

• Advanced cancer frequently causes severe, intractable pain impacting patient quality of life.
• Current analgesics and adjuvant therapies inadequately manage pain in 10%-15% of patients.
• Intercostal neurolysis with phenol is used for refractory cancer pain.

Observation:

• A 66-year-old female with metastatic adenoid cystic carcinoma developed paraplegia after phenol neurolysis.
• The patient experienced bilateral lower extremity weakness and sensory loss from T10 to S5.
• MRI revealed leptomeningeal metastasis and myelitis, suggesting phenol-induced complications.

Findings:

• Phenol injection for intercostal neurolysis resulted in severe neurological deficits.
• Potential complication pathways include phenol diffusion along spinal nerves or the paravertebral venous plexus.
• The case demonstrates a rare but significant risk associated with phenol neurolysis near the spine.

Implications:

• This case underscores the critical risks of phenol neurolysis, particularly its proximity to the spinal cord.
• Alternative neurolytic agents or techniques may be necessary to minimize neurological damage.
• Further research into safer pain management strategies for advanced cancer patients is warranted.