scholarly journals Successful Treatment of Central Pain in a Multiple Sclerosis Patient with Epidural Stimulation of the Dorsal Root Entry Zone

Pain Medicine ◽  
2010 ◽  
Vol 11 (1) ◽  
pp. 127-132 ◽  
Author(s):  
Adam R. Burkey ◽  
Shiyi Abla-Yao
Keyword(s):  
Multiple Sclerosis ◽  
Multiple Sclerosis Patient ◽  
Successful Treatment ◽  
Dorsal Root ◽  
Central Pain ◽  
Entry Zone ◽  
Epidural Stimulation ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
Stimulation Of

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.

scholarly journals Spinal cord injury below-level neuropathic pain relief with dorsal root entry zone microcoagulation performed caudal to level of complete spinal cord transection

2018 ◽  
Vol 28 (6) ◽  
pp. 612-620 ◽  
Author(s):  
Scott Falci ◽  
Charlotte Indeck ◽  
Dave Barnkow
Keyword(s):  
Spinal Cord ◽  
Dorsal Root ◽  
Spinal Cord Transection ◽  
Central Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
Cord Injury ◽  
Somatotopic Map ◽  
Neuronal Transmission

OBJECTIVESurgically created lesions of the spinal cord dorsal root entry zone (DREZ) to relieve central pain after spinal cord injury (SCI) have historically been performed at and cephalad to, but not below, the level of SCI. This study was initiated to investigate the validity of 3 proposed concepts regarding the DREZ in SCI central pain: 1) The spinal cord DREZ caudal to the level of SCI can be a primary generator of SCI below-level central pain. 2) Neuronal transmission from a DREZ that generates SCI below-level central pain to brain pain centers can be primarily through sympathetic nervous system (SNS) pathways. 3) Perceived SCI below-level central pain follows a unique somatotopic map of DREZ pain-generators.METHODSThree unique patients with both intractable SCI below-level central pain and complete spinal cord transection at the level of SCI were identified. All 3 patients had previously undergone surgical intervention to their spinal cords—only cephalad to the level of spinal cord transection—with either DREZ microcoagulation or cyst shunting, in failed attempts to relieve their SCI below-level central pain. Subsequent to these surgeries, DREZ lesioning of the spinal cord solely caudal to the level of complete spinal cord transection was performed using electrical intramedullary guidance. The follow-up period ranged from 1 1/2 to 11 years.RESULTSAll 3 patients in this study had complete or near-complete relief of all below-level neuropathic pain. The analyzed electrical data confirmed and enhanced a previously proposed somatotopic map of SCI below-level DREZ pain generators.CONCLUSIONSThe results of this study support the following hypotheses. 1) The spinal cord DREZ caudal to the level of SCI can be a primary generator of SCI below-level central pain. 2) Neuronal transmission from a DREZ that generates SCI below-level central pain to brain pain centers can be primarily through SNS pathways. 3) Perceived SCI below-level central pain follows a unique somatotopic map of DREZ pain generators.

Dorsal root entry zone microcoagulation for spinal cord injury—related central pain: operative intramedullary electrophysiological guidance and clinical outcome

2002 ◽  
Vol 97 (2) ◽  
pp. 193-200 ◽  
Author(s):  
Scott Falci ◽  
Lavar Best ◽  
Rick Bayles ◽  
Dan Lammertse ◽  
Charlotte Starnes
Keyword(s):  
Spinal Cord ◽  
Dorsal Root ◽  
Central Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Cord Injury ◽  
Electrical Data ◽  
Fine Print

Object. Surgically created lesions of the spinal cord dorsal root entry zone (DREZ) to relieve central pain after spinal cord injury (SCI) have historically resulted in modest outcomes. A review of the literature indicates that fair to good relief of pain is achieved in approximately 50% of patients when an empirical procedure is performed. This study was undertaken to determine if intramedullary electrical guidance in DREZ lesioning could improve outcomes in patients with SCI-induced central pain. Additionally, electrical data were used to determine if the spinal cord could be somatotopically mapped with regard to this pain of central origin. Methods. Forty-one patients with traumatic SCI and intractable central pain underwent DREZ lesioning in which intramedullary electrical guidance was conducted. In nine patients, recording of DREZ-related spontaneous electrical hyperactivity guided the lesioning process. In 32 patients, recording of DREZ-induced evoked electrical hyperactivity during transcutaneous C-fiber stimulation (TCS) additionally guided lesioning. The follow-up period ranged from 1 to 7 years. The analyzed electrical data allowed for somatotopic mapping of the spinal cord. Conclusions. Intramedullary electrical guidance of DREZ lesioning substantially improves pain outcomes in patients with traumatic SCI—induced central pain, compared with an empiric technique. The best outcome occurs when DREZ-related spontaneous electrical hyperactivity and evoked hyperactivity during TCS are both used to guide the DREZ lesioning procedure. With such guidance, 100% relief of pain was achieved in 84% of patients and 50 to 100% relief of pain in 88%. Somatotopic mapping of the electrical data led to a proposed pain mechanism for below-level pain, implicating the sympathetic nervous system.

Successful Treatment of Phantom Pain with Dorsal Root Entry Zone Coagulation

1988 ◽  
Vol 51 (2-5) ◽  
pp. 188-197 ◽  
Author(s):  
Stephen C. Saris ◽  
Robert P. Iacono ◽  
Blaine S. Nashold Jr.
Keyword(s):  
Successful Treatment ◽  
Dorsal Root ◽  
Phantom Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone

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.

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