Dorsal horn suction – A DREZ lesioning technique based on intrinsic cord tissue elasticity

Abstract

Aim and objective

The accuracy of the lesioning plays a crucial role in the results of Dorsal Root Entry Zone (DREZ) surgery. The DREZ lesioning utilizes different techniques: radiofrequency, laser, ultrasound, electrocoagulation, with the size and the shape of the lesions determined by the technical parameters of the respective technique. The aim of this study is to assess the effectiveness of the dorsal horn suctioning as a DREZ lesioning technique applied for the treatment of neuropathic pain of spinal cord and/or cauda equina injury origin. The geometry of the lesion was determined by the natural properties of the cord tissue itself.

Methods

The series of 20 patients, 18 men and 2 women, aged 24–66 years, with a mean age of 40 year were operated on using Sindou's Microsurgical DREZotomy technique, modified in such a way that the selective dorsal horn suctioning was performed as a lesioning method instead of bipolar electrocoagulation, because they suffered from chronic neuropathic pain as the sequel of spinal injuries. Success in pain relief has been defined as 50% or greater reduction in pain after surgery.

Results

Satisfactory long-term pain relief was achieved in 16 (80%) of patients.

Complete long-term pain relief was achieved in 12 (60%) of the patients.

Conclusion

Our results confirmed the dorsal horn suction as a feasible DREZ lesioning method.

Keywords

DREZ surgery - Dorsal horn suction - Neuropathic pain - Spinal injury

• References

• 1 Nashold B.S.. Paraplegia and pain. In: Nashold B.S., Ovelmen-Levitt J.. eds Deafferentation Pain Syndromes: Patophysiology and Treatment. Advances in Pain Research and Therapy. 1991. vol. 19 Raven Press. Ltd.; New York: 301-330
• 2 Boterell E.H., Callaghan J.C., Jousse A.T.. Pain in paraplegia. Clinical management and surgical treatment. Proc R Soc Med 1954; 47: 281-288
• 3 Rolando L.. Ricerche Anatomiche sulla Struttura del Midollo Spinale [in Italian]. Dizionairo Periodico di Medicina. 1824. Stamparia Reale; Torino:
• 4 Ovelmen-Levitt J. The neurobiology of the spinal cord dorsal horn and pathophysiology of neuropathic pain. In: Nashold BS, Pearlstein RD, eds. The DREZ Operation. Park Ridge: American Association of Neurological Surgeons; 1996:13e27. Illinois.
• 5 Cosman E.R., Nashold B.S., Ovelman-Levitt J.. Theoretical aspects of radiofrequency lesions in the dorsal root entry zone. Neurosurgery 1984; 15: 945-950
• 6 Levy W.J., Nutkiewicz A., Ditmore M., Watts C.. Laser induced dorsal root entry zone lesions for pain control. Report of three cases. J Neurosurg 1983; 59: 884-886
• 7 Dreval O.N.. Ultrasonic DREZ-operations for treatment of pain due to brachial plexus avulsion. Acta Neurochir (Wien) 1993; 122: 76-81
• 8 Sindou M.. Microsurgical DREZotomy (MDT) for pain, spasticity, and hyperactive bladder: a 20-year experience. Acta Neurochir (Wien) 1995; 137: 1-5
• 9 Sindou M., Quoex C., Balaydier C.. Fiber organization at the posterior spinal cord-rootlet junction in man. J Comp Neurol 1974; 153: 15-26
• 10 Mikičić D., Spaić M.. Biomechanical characteristic of the spinal cord. Bull Appl Comp Math 2002; 168-174 Bam XCIX
• 11 Spaić M., Marković N., Mikičić D., Ilić S., Milosavljević I.. The DREZ surgical treatment of chronic pain in traumatic paraplegia. Ind J Neurotr (IJNT) 2005; 02: 111-116
• 12 Ditunno J.F., Young W., Donovan W.H., Creasy G.. The international standards booklet for neurological and functional classification of spinal cord injury. Paraplegia 1994; 32: 70-80
• 13 Melzack R.. The Mc Gill pain questionnaire: major properties and scoring methods. Pain 1975; 01: 277-299
• 14 Iacono R.P., Aguirre M.L., Nashold B.S.. Anatomic examination of human dorsal root entry zone lesions. Appl Neurophysiol 1998; 51: 225-229
• 15 Young R.E.. Clinical experience with radiofrequency and laser DREZ-lesions. J Neurosurg 1990; 71: 715-720
• 16 Sindou M., Mertens P., Wael M.. Microsurgical DREZotomy for pain due to spinal cord and/or cauda equina injuries: long-term results in a series of 44 patients. Pain 2001; 92 1–2 152-171
• 17 Friedman A.H., Nashold B.S.. DREZ lesions for relief of pain related to spinal cord injury. J Neurosurg 1986; 65: 465-469
• 18 Rath S.A., Braun V., Soliman N., Antioniadis G., Richter H.P.. Results of DREZ coagulations for pain related to plexus lesions, spinal cord injuries and postherpetic neuralgia. Acta Neurochir (Wien) 1996; 138: 364-369
• 19 Spaić M., Marković N., Tadić R.. Microsurgical DREZotomy for pain of spinal cord and cauda equina injury origin: clinical characteristics of pain and implications for surgery in a series of 26 patients. Acta Neurochir (Wien) 2002; 144: 453-462
• 20 Falci S., Best L., Bayles R., Lammertse D., Starnes C.. Dorsal root entry zone microcoagulation for spinal cord injury-related central pain: operative intramedullary electrophysiological guidance and clinical outcome. J Neurosurg (Spine 2) 2002; 97: 193-200