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Microsurgical DREZotomy for pain due to spinal cord and/or cauda equina injuries: long‐term results in a series of 44 patients. (University of Lyon, Lyon, France) Pain. 2001;92:159–171.
Author(s) -
Sindou M,
Mertens P.,
Wael M.
Publication year - 2001
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1046/j.1533-2500.2001.1039_38.x
Subject(s) - medicine , conus medullaris , spinal cord , cauda equina , surgery , spinal cord injury , neuropathic pain , paraplegia , anesthesia , cord , hematoma , perioperative , psychiatry
This article reported on the long‐term results of the microsurgical approach to the dorsal root entry zone (DREZotomy) in a series of 44 patients suffering from unbearable neuropathic pain secondary to spine injury. The follow‐up ranged from 1 to 20 years. The series included 25 cases with conus medullaris, 12 with thoracic cord, 4 with cauda equina and 3 with cervical cord injuries. Surgery was performed in 37 cases at the pathological spinal cord levels that corresponded to the territory of the so‐called “segmental pain,” and in 7 cases, on the spinal cord levels below the lesion for “infralesional pain,” syndromes. Regarding pain characteristics, a good result was obtained in 88% of the cases with predominately paroxysmal pain as compared with 26% with continuous pain. There were no perioperative mortalities. Morbidity included cerebrospinal fluid leak (3 patients), wound infection (2 patients), subcutaneous hematoma (1 patient), and bacteremia (1 patient). Conclude that the inclusion of DREZ‐lesioning surgery in the neurosurgical armamentarium for treating “segmental” pain due to spinal cord injuries is justified. Comment by Ron Pawl, M.D., FAC This is a seminal report, because it provides long‐term (greater than 1 year, 71 months average) outcome from the dorsal root entry zone lesioning, at the site of and one level above and below the site of injury, for pain after spinal cord injury. This procedure was performed using a microsurgical open technique. Results were good (greater than 75% relief) in patients with regional pain syndromes, in the body segments related to the site of cord injury, that was paroxysmal pain, and after conus medullaris lesions, which were the greatest number of cases treated. Continuous pain, burning pain, and infralesional pain syndromes, below the site of the cord injury, were not significantly benefited. Unfortunately, the authors did not report on the psychological make‐up of the patients, which might provide some insight into good versus bad outcome.