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.

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.

Dorsal Root Entry Zone Lesions for the Treatment of Brachial Plexus Avulsion Injuries: A Follow-up Study

Neurosurgery ◽  
1988 ◽  
Vol 22 (2) ◽  
pp. 369-373 ◽  
Author(s):  
Allan H. Friedman ◽  
Blaine S. Nashold ◽  
Peter R. Bronec
Keyword(s):  
Pain Relief ◽  
Brachial Plexus ◽  
Dorsal Root ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Avulsion Injury ◽  
Brachial Plexus Avulsion ◽  
Root Entry Zone ◽  
Good Pain Relief

Abstract Dorsal root entry zone (DREZ) lesions have been shown to yield short term relief from the pain associated with a brachial plexus avulsion injury. Because of the propensity of pain to recur after neuroablative procedures, 39 patients with pain after a brachial plexus avulsion injury were observed for 14 months to 10 years after DREZ lesions were made. Fifty-four per cent of these patients were afforded good pain relief. Of 21 patients who had multiple small lesions made within the DREZ, 15 (72%) were afforded good pain relief. (Neurosurgery 22:369-373, 1988)

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.

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 Central Neuropathic Pain and Complex Regional Pain Syndrome Following Brachial Plexus Injury Treated Successfully With Dorsal Root Entry Zone Lesioning

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Erin McCormack ◽  
Mansour H Mathkour ◽  
Lora Wallis Kahn ◽  
Reda Tolba ◽  
Maged Guirguis ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Brachial Plexus ◽  
Dorsal Root ◽  
Brachial Plexus Injury ◽  
Pain Syndrome ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Central Neuropathic Pain ◽  
Root Entry Zone

Abstract INTRODUCTION Central neuropathic pain (CNP) and complex regional pain syndrome (CRPS) present as chronic, unrelenting, and disabling pain resulting from central and peripheral nervous system injuries. For patients who have failed conservative management, dorsal root entry zone (DREZ) lesioning may serve as an alternative for the management of intractable pain. METHODS A 36-yr-old male presented with complete right brachial plexus injury and avulsion of nerve roots following a motorcycle accident. He developed disabling type I CRPS of the right upper extremity. After failing medical therapy, he underwent a trial of conventional SCS using 2 percutaneous leads in the upper cervical spine but did not get topographical coverage. He underwent a second SCS trial with the placement of a paddle lead using burst therapy, but his initial partial pain relief subsided after 3 d. Subsequently, he underwent SCS removal, C2 to T1 right DREZ lesioning, and C4 to T1 laminoplasty. The patient gained a significant pain relief and became more functional. Five months postoperatively, he experienced an improvement in his pain and narcotic consumption. RESULTS Using an insulated neurotomy electrode, 2-mm-deep lesions were made at 75°C for 15 s. A total of 83 lesions were made from T2 to C3. Each lesion was spaced 1 mm apart. The impedance was less than 1000 ohms, which was consistent within an area of injury. Somatosensory and motor-evoked potentials were at baseline during the case without significant changes. CONCLUSION When SCS fails, lesioning of the dorsal root entry zone is a useful tool in the armamentarium for the management of refractory brachial plexus neuropathic pain.

Experimental Anatomical Considerations of the Dorsal Root Entry Zone Lesions for Pain Relief

1987 ◽  
Vol 50 (1-6) ◽  
pp. 420-424
Author(s):  
R. Kuroda ◽  
J. Nakatani ◽  
M. Kitano ◽  
Y. Yamada ◽  
A. Yorimae
Keyword(s):  
Pain Relief ◽  
Dorsal Root ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone

Dorsal root entry zone lesions for intractable pain after trauma to the conus medullaris and cauda equina

1995 ◽  
Vol 82 (1) ◽  
pp. 28-34 ◽  
Author(s):  
John H. Sampson ◽  
Robert E. Cashman ◽  
Blaine S. Nashold ◽  
Allan H. Friedman
Keyword(s):  
Dorsal Root ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Intractable Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Relieve Pain ◽  
Fine Print

✓ This review was undertaken to determine the efficacy of using dorsal root entry zone (DREZ) lesions to treat intractable pain caused by trauma to the conus medullaris and cauda equina. Traumatic lesions of this area are unique in that both the spinal cord and the peripheral nerve roots are injured. Although DREZ lesions have been shown to relieve pain of spinal cord origin in many patients, they have been shown not to relieve pain of peripheral nerve origin. Therefore, 39 patients with trauma to the conus medullaris and cauda equina who underwent DREZ lesioning for intractable pain were reviewed retrospectively. The results of this review demonstrate the efficacy of DREZ lesions in these patients. At a mean follow-up period of 3.0 years, 54% of patients were pain-free without medications, and 20% required only nonnarcotic analgesic drugs for pain that no longer interfered with their daily activities. Better outcomes were noted in patients with an incomplete neurological deficit, with pain having an “electrical” character, and with injuries due to blunt trauma. Operative complications included weakness (four patients), bladder or sexual dysfunction (three), cerebrospinal fluid leak (two), and wound infection (two), but overall, 79.5% of patients (31 of 39) were without serious complications. Complications were limited to patients with prior tissue damage at the surgical exploration site and were most prevalent in patients who underwent bilateral DREZ lesions. In conclusion, this preliminary report suggests that DREZ lesions may be useful in combating intractable pain from traumatic injuries to the conus medullaris and cauda equina, with some risk to neurological function that may be acceptable in this group of patients.

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