Selective posterior rhizotomy in the dorsal root entry zone for treatment of hyperspasticity and pain in the hemiplegic upper limb

Neurosurgery ◽  
1986 ◽  
Vol 18 (5) ◽  
pp. 587???95 ◽  
Author(s):  
M Sindou ◽  
J J Mifsud ◽  
D Boisson ◽  
A Goutelle
Keyword(s):  
Upper Limb ◽  
Dorsal Root ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
Selective Posterior Rhizotomy

Selective Posterior Rhizotomy in the Dorsal Root Entry Zone for Treatment of Hyperspasticity and Pain in the Hemiplegic Upper Limb

Neurosurgery ◽  
1986 ◽  
Vol 18 (5) ◽  
pp. 587-595 ◽  
Author(s):  
Marc Sindou ◽  
Jean Jacques Mifsud ◽  
Dominique Boisson ◽  
Alain Goutelle
Keyword(s):  
Motor Neurons ◽  
Upper Limb ◽  
Dorsal Root ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Beneficial Effects ◽  
Root Entry Zone ◽  
Inhibitory Circuitry ◽  
Severe Spasticity ◽  
Selective Posterior Rhizotomy

Abstract The authors report a series of 16 hemiplegic patients suffering from harmful spasticity in the upper limb and treated with selective posterior rhizotomy (SPR) in the dorsal root entry zone (DREZ). This severe spasticity was associated with irreducible abnormal postures in flexion in 11 cases and painful manifestations in 12. The method was introduced in 1972 on the basis of anatomical studies of the DREZ in humans, in which a topographical segregation of the root afferents, according to their anatomicofunctional destinations, has been shown. It consists of a DREZ microsurgical lesion 1 to 2 mm in depth and directed at a 45° angle, performed ventrolaterally in the posterolateral sulcus of the spinal cord and into the internal part of the Lissauer's tract. The procedure is carried out in each rootlet of the posterior roots considered to be responsible for the harmful spasticity. SPR interrupts selectively the (lateral) nociceptive and (central) myotactic afferent fibers connecting the motor neurons, while sparing most of the (medial) lemniscal fibers and the inhibitory circuitry of Lissauer's tract and the dorsal horn. The results were evaluated after a 1- to 12-year follow-up. There were no deaths and no general complications; in 1 case a loss of motility in the leg ipsilateral to the procedure occurred. The excess of spasticity was slightly diminished (2 cases), markedly reduced (9 cases), or totally abolished (5 cases), making possible an improvement in voluntary movements in 8 patients and at least a good passive mobilization in 7 further case. In 1 case only, a marked tendency for spasticity to return was observed. Of the 12 patients with painful manifestations, 9 were completely relieved and 3 improved. These beneficial effects on both spasticity and pain led to a gain in functional status in 93% of cases. This was achieved without impairing sensation in the upper limb in 8 cases and with its diminution only in the 8 others.

scholarly journals Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion: A Comprehensive Literature Review

2021 ◽  
Author(s):  
Axumawi Mike Hailu Gebreyohanes ◽  
Aminul Islam Ahmed ◽  
David Choi
Keyword(s):  
Brachial Plexus ◽  
Patient Outcomes ◽  
Dorsal Root ◽  
Cervical Spinal Cord ◽  
Entry Zone ◽  
Neurosurgical Procedure ◽  
Dorsal Root Entry Zone ◽  
Brachial Plexus Avulsion ◽  
Root Entry Zone ◽  
Comprehensive Literature Review

Abstract Dorsal root entry zone (DREZ) lesioning is a neurosurgical procedure that aims to relieve severe neuropathic pain in patients with brachial plexus avulsion by selectively destroying nociceptive neural structures in the posterior cervical spinal cord. Since the introduction of the procedure over 4 decades ago, the DREZ lesioning technique has undergone numerous modifications, with a variety of center- and surgeon-dependent technical differences and patient outcomes. We have reviewed the literature to discuss reported methods of DREZ lesioning and outcomes.

Dorsal root entry zone lesions for the treatment of post-herpetic neuralgia

1984 ◽  
Vol 60 (6) ◽  
pp. 1258-1262 ◽  
Author(s):  
Allan H. Friedman ◽  
Blaine S. Nashold ◽  
Janice Ovelmen-Levitt
Keyword(s):  
Pain Relief ◽  
Dorsal Root ◽  
Post Herpetic Neuralgia ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Adequate Pain Relief ◽  
Good Pain Relief ◽  
Transcutaneous Nerve Stimulation

✓ Post-herpetic pain was treated in 12 patients using dorsal root entry zone (DREZ) lesions. All patients had failed to receive adequate pain relief from conservative therapy consisting of transcutaneous nerve stimulation, carbamazepine, and/or amitriptyline. Dorsal root entry zone lesions were made to include the involved dermatomes plus one-half of the dermatomes above and below the painful areas. Eight patients reported good pain relief with follow-up periods ranging from 6 to 21 months. A ninth patient obtained satisfactory pain relief, but the superior 1 cm of the original painful area was not included in the distribution of the DREZ lesions. Patients whose lesions were performed using a thermally controlled lesion probe suffered no significant postoperative neurological deficit. Dorsal root entry zone lesions appeared to be a satisfactory treatment for post-herpetic neuralgia in patients who have failed to respond to more conservative modes of therapy.

Treatment of Refractory Pain after Brachial Plexus Avulsion with Dorsal Root Entry Zone Lesions

Neurosurgery ◽  
2001 ◽  
Vol 48 (6) ◽  
pp. 1269-1277 ◽  
Author(s):  
Madjid Samii ◽  
Steffani Bear-Henney ◽  
Wolf Lüdemann ◽  
Marcos Tatagiba ◽  
Ulrike Blömer
Keyword(s):  
Brachial Plexus ◽  
Dorsal Root ◽  
Intractable Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
Long Term Follow Up ◽  
Cervical Root

Abstract OBJECTIVE Significant numbers of patients experience intractable pain after brachial plexus root avulsions. Medications and surgical procedures such as amputation of the limb are often not successful in pain treatment. METHODS Forty-seven patients with intractable pain after traumatic cervical root avulsions were treated with dorsal root entry zone coagulation between 1980 and 1998. The dorsal root entry zone coagulation procedure was performed 4 months to 12 years after the trauma, and patients were monitored for up to 18 years (average follow-up period, 14 yr). RESULTS Immediately after surgery, 75% of patients experienced significant pain reduction; this value was reduced to 63% during long-term follow-up monitoring. Nine patients experienced major complications, including subdural hematomas (n = 2) and motor weakness of the lower limb (n = 7). Improved coagulation electrodes with thermistors that could produce smaller and more-accurate lesion sizes, which were introduced in 1989, significantly reduced the number of complications. CONCLUSION Central deafferentation pain that persists and becomes intractable among patients with traumatic cervical root avulsions has been difficult to treat in the past. Long-term follow-up monitoring of patients who underwent the dorsal root entry zone coagulation procedure in the cervical cord indicated that long-lasting satisfactory relief is possible for the majority of individuals, with acceptable morbidity rates.

Theoretical Aspects of Radiofrequency Lesions in the Dorsal Root Entry Zone

Neurosurgery ◽  
1984 ◽  
Vol 15 (6) ◽  
pp. 945-950 ◽  
Author(s):  
Eric R. Cosman ◽  
Blaine S. Nashold ◽  
Janice Ovelman-Levitt
Keyword(s):  
Dorsal Root ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
Radiofrequency Lesions

Dorsal root entry zone lesions to control central pain in paraplegics

1981 ◽  
Vol 55 (3) ◽  
pp. 414-419 ◽  
Author(s):  
Blaine S. Nashold ◽  
Elizabeth Bullitt
Keyword(s):  
Dorsal Root ◽  
Central Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Cord Injury ◽  
Fine Print

✓ Thirteen patients with intractable long-term pain following spinal cord injury and paraplegia were treated with dorsal root entry zone lesions placed at the level just above the transection. Pain relief of 50% or more was achieved in 11 of the 13 patients, with follow-up periods ranging from 5 to 38 months. A previous report showed that central pain from brachial plexus avulsion could be relieved by dorsal root entry zone lesions, and this technique has been extended to the central pain phenomena associated with spinal trauma and paraplegia.

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