Effective but near disastrous subarachnoid neurolysis for mechanical root pain in a paraplegic cancer patient

Case Report: A 43-year-old white man with advanced renal cell carcinoma and consequent paraplegia complained of the new onset of lancinating pain involving the right upper chest wall. This pain, which was superimposed on well-controlled chronic back pain and was intermittent and related to activity, failed to respond to conventional pharmacologic management. Methods and Results: A cisternal myelogram suggested an absence of gross rostral extension of spinal metastases, and subarachnoid neurolysis was performed with hyperbaric phenol. Unexpected contralateral brachial weakness developed towards the conclusion of the procedure, but resolved spontaneously. The target pain had not recurred at follow-up 8 months later.