Our data demonstrate that approximately 23-29% of standard dorsal root entry zone (DREZ) microcoagulation procedures fail to relieve pain due to inadequate thermal lesions and that approximately 39% fail due to insufficient superior extent of lesions. The remaining failures are related to inadequate lesion placement, improper selection of patients, and, rarely, posttraumatic spinal deafferentation pain resulting from other non-DREZ mechanisms. Computer-assisted DREZ microcoagulation is a satisfactory procedure to treat intractable posttraumatic spinal deafferentation pain, brachial plexus avulsion pain, and lumbosacral nerve root avulsion pain. In all these conditions we have identified areas of abnormal focal hyperactivity in the DREZ area. Perhaps this procedure can be applied to other central pain conditions if, using this technique, abnormal focal hyperactivity is demonstrated to be present.
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Neuropathic pain relief and altered brain networks after dorsal root entry zone microcoagulation in patients with spinal cord injury.
Brain Commun
November 2024
Spaulding Neuroimaging Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA.
Article Synopsis
- Spinal cord injury (SCI) below-level neuropathic pain is challenging to treat, but surgical lesions in the spinal cord’s dorsal root entry zone (DREZ) can target pain sources effectively.
- A study with eight patients showed significant improvement in pain relief after neuroelectrically guided DREZ microcoagulation surgery, with some experiencing long-term relief for over a year.
- Changes in brain connectivity were observed post-surgery, indicating that the procedure not only alleviated pain but also normalized brain function related to sensory and motor processing.
Spinal cord injury below-level neuropathic pain relief with dorsal root entry zone microcoagulation performed caudal to level of complete spinal cord transection.
J Neurosurg Spine
June 2018
2Medsurant, LLC, Englewood, Colorado.
OBJECTIVE Surgically 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.
View Article and Find Full Text PDFMicrocoagulation of junctional dorsal root entry zone is effective treatment of brachial plexus avulsion pain: long-term follow-up study.
Croat Med J
April 2006
Department of Neurosurgery, Ljubljana University Medical Center, Ljubljana, Slovenia.
Aim: To analyze long-term clinical results of coagulation lesions of the dorsal root entry zone (DREZ) in patients with deafferentation pain due to brachial plexus avulsion and to correlate the pain relief after DREZ coagulation with pain duration before the DREZ coagulation.
Methods: Twenty-six patients with intractable deafferentation pain after brachial plexus avulsion lesion were treated for pain at the Department of Neurosurgery. Junctional coagulation lesion was made with bipolar forceps along the DREZ.
Dorsal root entry zone microcoagulation for spinal cord injury-related central pain: operative intramedullary electrophysiological guidance and clinical outcome.
J Neurosurg
September 2002
Department of Neurosurgery, Physical Medicine and Rehabilitation, Craig Hospital, Englewood, Colorado, USA.
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.
View Article and Find Full Text PDF[Central nervous pain in patients with spinal cord injury. Medical and surgical treatment].
Tidsskr Nor Laegeforen
May 1997
Nevrologisk avdeling, Haukeland Sykehus, Bergen.
About 50% of patients with spinal cord injury suffer from persistent central neurogenic pain. The authors review the case of a patient with traumatic paraplegia who developed persistent central neurogenic pain. The pain was described as burning in the buttock area, icing in the rectum area and as lancinating pain to the lower extremities.
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