Section of the rami communicantes (ramicosection, ramicotomy) has in general fallen from favour, due to technical difficulties and uncertainty of correct operative technique. It is simplest to section these nerves in the lower thoracic region. The fibres can be found at the intervertebral nerve canal alongside the spinal column, after removal of the lateral processes of the vertebrae and after incision of the back muscles. Here one can distinguish the required ramus and section it. We ourselves — after a few such procedures (3) of this type — have discontinued this operation. Briinning (1924) has detailed the disadvantages. Ramicotomy, or ramiectomy, used to be performed in abdominal complaints of no anatomical basis, in the pain of pharyngitis, with painful amputation stumps, tabetic crises, and in bronchial asthma. Leriche and Fontaine (1926) reported a series of 14 cases with operation of a lower cervical and first thoracic root, with post-operative pain in the operative field, headache, gastrointestinal trouble and upper respiratory difficulties. Time has shown that these results are not at all unusual, so that this operation has become obsolete.
Alcohol infiltration of the cord. This was discovered by Dogliotti (1931), who has maintained the technique with other surgeons trained along these lines. The purpose of the procedure is to destroy the lower sacral sensory fibres by means of absolute alcohol. This is injected into the patient’s spinal canal, with the patient in a position to ensure that the alcohol (of lower specific gravity than cerebrospinal fluid) reaches the desired roots. Alcohol affects primarily unmyelinated and С fibres, but does not involve A and Ð’ fibres, i. е., it acts against pain, temperature perception and the sympathetics, and does not affect touch sensation. These alcohol infiltrations are used in cases of pain with inoperable malignant growths of the prostate, urinary bladder and lower segments of the appendix. They may have unpleasant side-effects of faecal incontinence and urinary retention. Some of these patients had paresis of the lower extremities and others paraesthesias accompanied by severe pain. Up to 50% relief of pain, on the average, for a period of 3—4 months, can be obtained without the above-mentioned side-effects (Hay et al., 1959). This procedure is indicated for exhausted patients, where a more extensive intervention would be intolerable and relief of pain in their last weeks can be purchased at the price of a few side-effects.