Dorsal Root Entry Zone Lesion, Midline Myelotomy and Anterolateral Cordotomy

Konrad, Peter E.

doi:10.1016/j.nec.2014.07.010

Cited by 22 publications

(20 citation statements)

References 88 publications

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“…nerve root avulsions). It is particularly effective in controlling the paroxysmal pain but not so much in the constant aspect of it [23-25, 84,133,139,142]. It provides a better pain control than the neuromodulation procedures, with a reported long-term success rates of 50-75% [22, 25, 29, 48,143].…”

Section: Ablative Proceduresmentioning

confidence: 99%

“…The DREZ-otomy can be created microsurgicaly (Sindou's technique) [25], with radiofrequency (Nashold's technique) [29,48], with laser [153][154][155][156] or even with an ultrasonic microprobe [131], but there are no major differences in pain control or patients' quality of life between them [142,156]. The microsurgical technique is performed with the regular bipolar forceps, which is less expensive than the other options (radiofrequency, laser, ultrasonic probe), making it ideal for countries with limited resources [144,157].…”

Section: Treatment Of Brachial Plexus Injuries 108mentioning

confidence: 99%

See 1 more Smart Citation

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Saiz-Sapena¹,

Vanaclocha‐Vanaclocha²,

Ortiz-Criado³

et al. 2019

Treatment of Brachial Plexus Injuries

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Brachial plexus injuries are commonly followed by chronic pain, mostly with neuropathic characteristics. This is due to peripheral nerve lesions, particularly nerve root avulsions, as well as upper limb amputations, and complex regional pain syndrome (CRPS). The differential diagnosis between CRPS and neuropathic pain is essential as the treatment is different for each of them. Medical treatments are the first step, but for refractory cases there are two main types of surgical alternatives: ablative techniques and neuromodulation. The first group involves destruction of the posterior horn deafferented neurons and usually provides a better pain control but has a 10% complication rate. The second group provides pain control with function preservation but with limited effectiveness. Each case has to be thoroughly evaluated to apply the treatment modality best suited for it. due to iatrogenia [8][9][10][11][12][13][14][15][16], particularly during lymph node biopsy [17, 18] or treatment of some malignancies [19]. The pain is chronic [20], persistent [7], constant [21], burning [22] and throbbing [17], with paroxysmal discharges [3, 6, 23], particularly upon gentle rubbing the affected area [4].The pain is distributed in the distal areas of the upper limb, covering several dermatomes, mostly the caudal ones [24] and particularly the hand [5, 17, 23, 25]. The paroxysmal pain is felt in the arm [26]. Allodynia, hypersensitivity and electric-like discharges are present at the border between the normal and affected dermatomes [17,[26][27][28][29], particularly between T 1 and T 2 at the posterior aspect of the elbow [26].The pain severity correlates with the magnitude of the brachial plexus injury [2,3] and to the number of avulsed nerve roots [2-4, 21, 26, 30-33], particularly when the lower roots are affected [24,34,35]. Nevertheless, Bertelli et al. [21] found that in isolated C 8 and T 1 nerve root avulsions, there was no pain at all.The pain does not appear immediately after the injury but a few days later [24] and no longer than 3 months after it [5, 6, 24, 26,35,36].The neuropathic pain can be associated with phantom [37] or stump pain [38] in case of upper limb amputation, or to complex regional pain syndrome (CRPS) [6], inducing a complex pain condition rather difficult to control [19,30,31].Self-mutilation has been described in 5-29% of obstetric brachial plexus injury cases [39,40].The quality of life is seriously impaired with sleep disorders, family troubles, unemployment, chronic depression and social withdrawal [2, 5, 6, 17, 21,[41][42][43][44]. Additionally, the chronic pain is a further hindrance to comply with a good rehabilitation programme, impairing a possible functional recovery [6,45,46]. Among all the disabilities induced by the brachial plexus injury, the pain has been found to be the symptom that most negatively affects the quality of life [47].Treatment of this chronic pain can be troublesome, as the response to the different treatment modalities is poor and not all of them allow preservatio...

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Section: Ablative Proceduresmentioning

confidence: 99%

Section: Treatment Of Brachial Plexus Injuries 108mentioning

confidence: 99%

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Saiz-Sapena¹,

Vanaclocha‐Vanaclocha²,

Ortiz-Criado³

et al. 2019

Treatment of Brachial Plexus Injuries

View full text Add to dashboard Cite

show abstract

“…The existence of several classification schemes for these lesions reflect the variety of mechanisms and established lesions and, at least in part, can be related to the diversity of pain patterns. Historically, DREZ selective lesioning through microsurgical incision (Sindou technique) or with radiofrequency thermocoagulation (Nashold technique) is particularly effective for the treatment of the paroxysmal component of the pain . DREZ has shown greatest improvements in paroxysmal pain; two‐thirds of patients improved long term, yet as many as 10% experience dysesthesia and ipsilateral leg weakness .…”

Section: Discussionmentioning

confidence: 99%

Thalamic Deep Brain Stimulation for Neuropathic Pain: Efficacy at Three Years’ Follow-Up

Abreu

Vaz

Rebelo

et al. 2017

Neuromodulation: Technology at the Neural Interface

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“…4,5 Underuse of cordotomy may be due to unfamiliarity, reluctance, and/or insufficient experience to perform palliative ablative procedures safely and effectively, even in the neurosurgery community. [8][9][10]13 Many neuroradiologists frequently perform similar CT-guided spine procedures and ablations. These neuroradiologists can provide the missing expertise to safely perform this procedure as part of a multidisciplinary team for improved patient care.…”

Section: Discussionmentioning

confidence: 99%

“…12 Recent improvements in pain management have reduced the need for cordotomy to the point that the neurosurgery community is concerned that expertise in this procedure is disappearing. [8][9][10]13 Only 3 medical centers in the United States have reported performing cordotomy during the past decade. 12,[14][15][16][17] Yet, a subset of patients with end-stage cancer with persistent incapacitating extremity pain not relieved by medical and intrathecal therapy could benefit from cordotomy if it were offered.…”

mentioning

confidence: 99%

Palliative CT-Guided Cordotomy for Medically Intractable Pain in Patients with Cancer

Shepherd¹,

Hoch²,

Cohen³

et al. 2016

AJNR Am J Neuroradiol

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SUMMARY:Palliative cervical cordotomy can be performed via percutaneous radiofrequency ablation of the lateral C1-2 spinothalamic tract. This rare procedure can be safe, effective, and advantageous in mitigating medically intractable unilateral extremity pain for selected patients with end-stage cancer. This report reviews the indications, techniques, risks, and potential benefits of cordotomy. We describe our recent experience treating 3 patients with CT-guided C1-2 cordotomy and provide the first characterization of spinal cord diffusion MR imaging changes associated with successful cordotomy.

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Dorsal Root Entry Zone Lesion, Midline Myelotomy and Anterolateral Cordotomy

Cited by 22 publications

References 88 publications

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Thalamic Deep Brain Stimulation for Neuropathic Pain: Efficacy at Three Years’ Follow-Up

Palliative CT-Guided Cordotomy for Medically Intractable Pain in Patients with Cancer

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