Bilateral cortical stimulation for deafferentation pain after spinal cord injury

2004 ◽  
Vol 101 (4) ◽  
pp. 687-689 ◽  
Author(s):  
Naoki Tani ◽  
Youichi Saitoh ◽  
Masayuki Hirata ◽  
Amami Kato ◽  
Toshiki Yoshimine
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Intractable Pain ◽  
Entry Zone ◽  
Content Type ◽  
Deafferentation Pain ◽  
Root Entry Zone ◽  
Thalamic Stimulation ◽  
Cord Injury ◽  
New Treatment

✓ The relief of intractable pain after spinal cord injury (SCI) is very difficult to obtain, even with dorsal root entry zone lesioning, spinal cord stimulation, and thalamic stimulation. Using bilateral motor cortex stimulation (MCS) the authors successfully treated a woman who experienced deafferentation pain 4 years after sustaining an SCI. To the authors' knowledge, this is the first report of bilateral MCS for pain relief after SCI. The success they achieved using this method indicates that MCS could be a new treatment option for deafferentation pain following SCI.

DREZ lesions for relief of pain related to spinal cord injury

1986 ◽  
Vol 65 (4) ◽  
pp. 465-479 ◽  
Author(s):  
Allan H. Friedman ◽  
Blaine S. Nashold
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pain Relief ◽  
Intractable Pain ◽  
Content Type ◽  
Root Entry Zone ◽  
Pain Syndromes ◽  
Cord Injury ◽  
Good Pain Relief

✓ Fifty-six patients with intractable pain following a spinal cord injury were treated with dorsal root entry zone (DREZ) lesions. After a follow-up period ranging from 6 months to 6 years, 50% of patients had good pain relief. Certain pain syndromes tended to respond better to DREZ lesions than did others. Patients with pain extending caudally from the level of the injury and patients with unilateral pain were most likely to obtain pain relief from the procedure; diffuse pain and predominant sacral pain did not respond as well.

Laser-induced dorsal root entry zone lesions for pain control

1983 ◽  
Vol 59 (5) ◽  
pp. 884-886 ◽  
Author(s):  
Walter J. Levy ◽  
Alan Nutkiewicz ◽  
Q. Michael Ditmore ◽  
Clark Watts
Keyword(s):  
Spinal Cord ◽  
Dorsal Root ◽  
Scar Tissue ◽  
Intractable Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Cord Injury ◽  
Alternative Means

✓ Dorsal root entry zone lesions have been documented as effective for control of intractable pain in patients with brachial plexus avulsion or severe spinal cord injury. These lesions are usually made with the radiofrequency technique. The authors report three cases in which the CO2 laser was used as an alternative means of making the lesions. This latter technique provided effective pain relief in two of the patients and was efficient to use. It was noted that the presence of overlying scar tissue can be deceptive in judging the depth of the lesion made with the laser. The CO2 laser provided a means of producing controlled spinal cord lesions which may be more precise than the radiofrequency method.

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.

Intractable pain of spinal cord origin: clinical features and implications for surgery

1992 ◽  
Vol 77 (3) ◽  
pp. 373-378 ◽  
Author(s):  
Ronald R. Tasker ◽  
Gervasio T. C. DeCarvalho ◽  
Eugen J. Dolan
Keyword(s):  
Spinal Cord ◽  
Clinical Features ◽  
Surgical Procedures ◽  
Brain Stimulation ◽  
Dorsal Root ◽  
Intractable Pain ◽  
Vertebral Level ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone

✓ The clinical features and types of pain affecting 127 patients with central pain caused by lesions in the spinal cord were studied and correlated with the results of surgical procedures performed on 103 of them. The surgical procedures consisted of percutaneous cordotomy in 39 cases, cordectomy in 12, dorsal root entry zone (DREZ) surgery in four, dorsal cord stimulation in 35, and brain stimulation in 13. The three most common types of pain in the 127 patients were characterized as: steady in 95% of cases, intermittent (usually shooting) in 31%, and evoked (allodynia, hyperpathia, or hyperesthesia) in 45%. Steady pain was usually causalgic (74.8%) or dysesthetic (27.6%). The only obvious clinical correlation with pain type was the association of intermittent pain with lesions at the T10-L2 vertebral level. Destructive surgery (cordotomy, DREZ surgery, or cordectomy) affected the three chief types of pain differently from treatment with cord or brain stimulation. Destructive surgery resulted in reduction of steady pain in 26% of affected cases, of intermittent pain in 89%, and of evoked pain in 84%, while stimulation resulted in pain reductions in 36%, 0%, and 16% of cases, respectively. The differential effect of destructive surgery on steady and intermittent pain is consistent with published experience. These observations suggest differing mechanisms for the three types of pain.

Dorsal Root Entry Zone Lesioning Used to Treat Central Neuropathic Pain in Patients With Traumatic Spinal Cord Injury

Spine ◽  
2002 ◽  
Vol 27 (7) ◽  
pp. E177-E184 ◽  
Author(s):  
Matthew R. Denkers ◽  
Heather L. Biagi ◽  
Mary Ann O’Brien ◽  
Alejandro R. Jadad ◽  
Mary E. Gauld
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neuropathic Pain ◽  
Dorsal Root ◽  
Traumatic Spinal Cord Injury ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Central Neuropathic Pain ◽  
Root Entry Zone ◽  
Cord Injury

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.

Spinal Cord Injury Transitional Zone Pain

2019 ◽  
pp. 89-94
Author(s):  
Oren Sagher
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Transitional Zone ◽  
Treatment Modalities ◽  
Neurosurgical Procedures ◽  
Deafferentation Pain ◽  
Root Entry Zone ◽  
Cord Injury ◽  
Spinal Cord Injury Pain ◽  
Clinical Problems

The treatment of spinal cord injury pain is one of the most challenging clinical problems in pain neurosurgery. It represents a type of deafferentation pain that resists most treatment modalities. And while ablative neurosurgical procedures have largely been abandoned in the treatment of deafferentation pain, it still plays an important role in transitional zone pain. This chapter outlines the essential clinical features of transitional zone pain following spinal cord injury and describes the use of dorsal root entry zone lesioning (DREZ) in its management. The decision-making process involved in offering this procedure is nuanced, and this chapter provides key considerations important in counseling patients prior to surgery.

scholarly journals Neuropathic Pain Post Spinal Cord Injury Part 2: Systematic Review of Dorsal Root Entry Zone Procedure

2013 ◽  
Vol 19 (1) ◽  
pp. 78-86 ◽  
Author(s):  
Swati Mehta ◽  
Katherine Orenczuk ◽  
Amanda McIntyre ◽  
Gabrielle Willems ◽  
Dalton Wolfe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neuropathic Pain ◽  
Dorsal Root ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
Cord Injury
Sign in / Sign up

Export Citation Format

Share Document