scholarly journals Reconstruction of the Damaged Dorsal Root Entry Zone by Transplantation of Olfactory Ensheathing Cells

2019 ◽  
Vol 28 (9-10) ◽  
pp. 1212-1219 ◽  
Author(s):  
Andrew Collins ◽  
Ahmed Ibrahim ◽  
Daqing Li ◽  
Modinat Liadi ◽  
Ying Li
Keyword(s):  
Spinal Cord ◽  
Nervous System ◽  
Dorsal Root ◽  
Spinal Cord Injuries ◽  
Dorsal Column ◽  
Olfactory Ensheathing Cells ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
Ensheathing Cells

The dorsal root entry zone is often used in research to examine the disconnection between the central and peripheral parts of the nervous system which occurs following injury. Our laboratory and others have used transplantation of olfactory ensheathing cells (OECs) to repair experimental spinal cord injuries. We have previously used a four dorsal root (C6–T1) transection model to show that transplantation of OECs can reinstate rat forelimb proprioception in a climbing task. Until now, however, we have not looked in detail at the anatomical interaction between OECs and the peripheral/central nervous system regions which form the transitional zone. In this study, we compared short- and long-term OEC survival and their interaction with the surrounding dorsal root tissue. We reveal how transplanted OECs orient toward the spinal cord and allow newly formed axons to travel across into the dorsal horn of the spinal cord. Reconstruction of the dorsal root entry zone was supported by OEC ensheathment of axons at the injured site and also at around 3 mm further away at the dorsal root ganglion. Quantitative analysis revealed no observable difference in dorsal column axonal loss between transplanted and control groups of rats.

Dorsal root entry zone lesions for pain relief

1979 ◽  
Vol 51 (1) ◽  
pp. 59-69 ◽  
Author(s):  
Blaine S. Nashold ◽  
Roger H. Ostdahl
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Brachial Plexus ◽  
Dorsal Root ◽  
Dorsal Column ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Content Type ◽  
Arm Pain ◽  
Root Entry Zone

✓ Arm pain due to avulsion of the cervical dorsal roots of the brachial plexus may become intractable, ameliorated little, if at all, by contemporary medical or surgical treatment. Severe and sudden trauma to the neck, shoulder, or arm is the usual cause of avulsion of the cervical rootlets. The injury may result in complete sensorimotor paralysis of the involved extremity, or a partial deficit if only a few rootlets are involved. Previous therapies have included stellate block, sympathectomy, high cervical cordotomy, rhizotomy, transcutaneous stimulation, dorsal column stimulation, mesencephalic tractotomy, cingulotomy, and the use of narcotics. The extent of the pathological change in the spinal cord following root avulsion is not completely known; at the time of operation, abnormalities frequently noted included ipsilateral atrophy of the dorsal aspect of the cord, dense arachnoid scarring, microcyst formation, and loss of both dorsal and ventral roots. The cervical myelogram is abnormal, although not necessarily pathognomonic of the extent of injury. The surgical technique of coagulation of the dorsal root entry zone is discussed, and the results and morbidity in 21 patients are reviewed. Thirteen patients (67%) continue to have good pain relief, with follow-up periods ranging from 6 months to 3½ years. Three patients with extremity pain from other causes are included in the series. Clinical observations suggest the possibility that pain resulting from brachial plexus avulsion originates from pathophysiological changes in the injured dorsal horn of the spinal cord. This report is a discussion of a new technique aimed at destruction of the dorsal root entry zone for relief of chronic extremity pain.

scholarly journals Dorsal Root Entry Zone Lesioning: Systematic Review

2020 ◽  
Author(s):  
Giovanna Zambo Galafassi ◽  
Paulo Henrique Pires Aguiar ◽  
André Akira Takahashi ◽  
Jorge Roberto Pagura
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Chronic Pain ◽  
Dorsal Root ◽  
Spinal Cord Injuries ◽  
Lumbosacral Plexus ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
The Impact

Abstract Introduction Dorsal root entry zone (DREZ) leasioning (DREZ-otomy) is considered an effective treatment for chronic pain due to spinal cord injuries, brachial and lumbosacral plexus injuries, postherpetic neuralgia, spasticity, and other conditions. The objective of the technique is to cause a selective destruction of the afferent pain fibers located in the dorsal region of the spinal cord. Objective To identify and review the effectiveness and the main aspects related to DREZ-otomy, as well as the etiologies that can be treated with it. Methods The PubMed, MEDLINE and LILACS databases were used as bases for this systematic review, having the impact factor as the selection criteria. The 23 selected publications, totalizing 1,099 patients, were organized in a table for systematic analysis. Results Satisfactory pain control was observed in 70.1% of the cases, with the best results being found in patients with brachial/lumbosacral plexus injury (70.8%) and the worst, in patients with trigeminal pain (40% to 67%). Discussion Most of the published articles observed excellent results in the control of chronic pain, especially in cases of plexus injuries. Complications are rare, and can be minimized with the use of new technologies for intraoperative monitoring and imaging. Conclusion DREZ-otomy can be considered a great alternative for the treatment of chronic pain, especially in patients who do not tolerate the side effects of the medications used in the clinical management or have refractory pain.

Spinal cord mapping with evoked responses for accurate localization of the dorsal root entry zone

1995 ◽  
Vol 82 (4) ◽  
pp. 587-591 ◽  
Author(s):  
Mahmood Fazl ◽  
David A. Houlden ◽  
Zelma Kiss
Keyword(s):  
Spinal Cord ◽  
Dorsal Root ◽  
Neurological Deficits ◽  
Intractable Pain ◽  
Specific Stimulus ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Accurate Localization

✓ Direct spinal cord stimulation and recording techniques were used intraoperatively to localize the dorsal root entry zone (DREZ) in four patients with brachial plexus avulsion and severe intractable pain. The spinal cord was stimulated by a cordotomy needle placed on the pia-arachnoid at the DREZ or the dorsal or dorsolateral aspect of the spinal cord. Recordings were obtained from a subdural silver ball electrode placed rostral or caudal to the stimulation site. Spinal cord conduction velocity was significantly faster following dorsolateral stimulation than dorsal stimulation (mean = 66 and 45 m/sec respectively). The spinal cord evoked potential was significantly larger in amplitude following dorsolateral stimulation than dorsal stimulation at a specific stimulus intensity. Stimulation at the DREZ failed to evoke a response. These neurophysiological phenomena helped to accurately localize the DREZ before DREZ lesioning was undertaken. There were no untoward neurological deficits related to the DREZ lesions and all patients had satisfactory pain relief following the procedure. Intraoperative spinal cord mapping facilitates accurate DREZ localization when the DREZ cannot be visually identified.

scholarly journals Neurosurgical treatment of pain

2006 ◽  
Vol 59 (9-10) ◽  
pp. 450-455
Author(s):  
Eugen Slavik
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Surgical Treatment ◽  
Spinal Cord Stimulation ◽  
Dorsal Root ◽  
Neurosurgical Procedures ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
Deep Brain

Introduction. Surgical treatment of chronic pain includes destructive procedures (neurectomy, rhizotomy, sympathectomy), often referred to as ablative, and accompanied by high morbidity and mortality rates. Surgical treatment of pain. During the past three decades, thanks to current knowledge on chronic pain mechanisms and technological developments, such as improved microsurgical and stereotactic techniques, guided by computerized tomography, magnetic resonance imaging and neural tissue impedance monitoring, the majority of ablative procedures have been replaced by new methods. Among them, a few can be considered as selectively and minimally ablative (microsurgical spinothalamic cordotomy, dorsal root entry zone lesions, limited midline myelotomy) and others as neuroaugumentative procedures for neuromodulatory processes (deep brain structures and spinal cord stimulation, drug-delivery systems). Neurosurgical procedures. Cordotomy is very effective in pain treatment and it may produce complete abolishment of pain, especially in patients suffering from neoplastic invasion of the brachial plexus (Pancoast?s syndrome) or lumbosacral plexus. Dorsal root entry zone operation is generally the only treatment option for pain due to root avulsion and segmental pain in spinal cord injury. Spinal cord stimulation is useful in management of pain following peripheral nerve injury. Deep brain stimulation is a promising treatment of central pain. Conclusion. The purpose of this review is to draw attention to neurosurgical approaches to treatment of chronic and opioid-resistant pain. .

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.

Sign in / Sign up

Export Citation Format

Share Document