Pain and spinal cysts in paraplegia: Treatment by drainage and DREZ operation

Nashold, Blaine S.; Vieira, José Campos Linhares; El-Naggar, Amr

doi:10.3109/02688699008992742

Cited by 27 publications

(12 citation statements)

References 10 publications

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“…At follow-up 1 week to 619 weeks later (average of 156 weeks), individuals assessed their pain relief as "good" if they required no analgesics, "fair" if pain was significantly reduced but they still required nonnarcotic analgesics, or "poor" for any other scenario. Similarly, Nashold et al 16 …”

Section: Effectiveness Of the Drez Proceduresmentioning

confidence: 99%

“…Six studies included individuals with only neuropathic pain, 6,9,14,15,17,20 and 3 studies included individuals with mixed pain 8,16,19 ; in 2 studies the origin of pain was not indicated. 7,18 The presence of neuropathic pain was determined by means of a clinical interview or pain descriptors.…”

Section: Methodsmentioning

confidence: 99%

“…15 Five studies involved individuals who underwent a radiofrequency-induced DREZ procedure. 2,7,8,16,18 Friedman and Nashold 7 performed the procedure between 1978 and 1986 on 56 individuals who were experiencing pain associated with an SCI. At follow-up 6 months to 5 years after the procedure, individuals assessed their pain relief as "good" if they were pain free or did not require analgesics or the pain did not interfere with daily activities, "fair" if they only required nonnarcotic analgesics, or "poor" if they still had residual pain that interfered with their daily activities.…”

Section: Methodsmentioning

confidence: 99%

“…One study conducted a prospective controlled trial, 14 1 utilized a pre-post study design, 9 and 9 studies utilized a case series study design [6][7][8][15][16][17][18][19][20] (see Table 2). In each study, an intervention for pain was administered to an individual with SCI, and the change in pain was measured; only 1 study compared treated individuals with those in a control group.…”

Section: Methodsmentioning

confidence: 99%

“…One study provided level 2 evidence, 14 and 10 provided level 4 evidence. 4,[6][7][8][9][15][16][17][18][19][20] Sample sizes ranged from 6 to 56. Ages of individuals in the studies ranged from 17 to 75 years, with an average age of 39 years.…”

Section: Study Size and Qualitymentioning

confidence: 99%

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

Mehta

Orenczuk

McIntyre

et al. 2013

Topics in Spinal Cord Injury Rehabilitation

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Background: Pharmacotherapy may not sufficiently reduce neuropathic pain in many individuals post spinal cord injury (SCI). The use of alternative therapies such as surgery may be effective in reducing neuropathic pain in these individuals. However, because of the invasive nature of surgery, it is important to examine the evidence for use of this treatment. Objective: The purpose of this study was to conduct a systematic review of published literature on the surgical treatment of neuropathic pain after SCI. Methods: MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for articles in which surgical treatment of pain after SCI was examined. Articles were restricted to the English language. Article selection was conducted by 2 independent reviewers with the following inclusion criteria: the subjects participated in a surgical intervention for neuropathic pain; at least 50% of the subjects had an SCI; at least 3 subjects had an SCI; and a definable intervention involving the dorsal root entry zone (DREZ) procedure was used to reduce pain. Data extracted included study design, study type, subject demographics, inclusion and exclusion criteria, sample size, outcome measures, and study results. Randomized controlled trials (RCTs) were assessed for quality using the Physiotherapy Evidence Database (PEDro) assessment scale. Levels of evidence were assigned to each intervention using a modified Sackett scale. Results: Eleven studies met the inclusion criteria. One study provided level 2 evidence, and the rest provided level 4 evidence. The DREZ procedure was shown to be more effective for segmental pain than for diffuse pain after SCI. Further, individuals with conus medullaris level injury were found to have a higher level of neuropathic pain relief than those with cervical, thoracic, or cauda equina injury. Conclusions: The studies demonstrated that the DREZ procedure may be effective in reducing segmental pain. Hence, DREZ may be important in treatment of neuropathic pain in individuals resistant to less invasive treatments. Because the studies lacked control conditions and examination of long-term effects, there is a need for larger trials with more stringent conditions.

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Section: Effectiveness Of the Drez Proceduresmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Study Size and Qualitymentioning

confidence: 99%

See 3 more Smart Citations

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

Mehta

Orenczuk

McIntyre

et al. 2013

Topics in Spinal Cord Injury Rehabilitation

View full text Add to dashboard Cite

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Microsurgical anatomy of dorsal root entry zone of brachial plexus

Xiang

Liu

et al. 2007

Microsurgery

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The purpose of this study was to describe microsurgical anatomy of the dorsal root entry zone (DREZ) and provide an anatomic basis for the approach of DREZ lesion in treating radiculopathy of brachial plexus avulsion injuries. We studied 100 dorsal cervical roots and DREZ/ posterior horn complexes in 20 adult cadavers. At each root level the following data were recorded: widths of laminectomy, numbers of posterior rootlets, angle of the inferior rootlets with the spinal cord, and distance from posterior median sulcus to posterolateral sulcus. On cross-sectional plane, the length and width of dorsal horn and the angle between longitudinal axis of dorsal horn and sagittal plane of spinal cord were measured. The results showed that the spinal cord segment and the entry of dorsal roots from C5 to T1 were exposed clearly after laminectomy from C4 to C7. The average number of roolets of C5-T1 roots was about 7.76 and C6 has the most. From up to down, the angle from the inferior rootlet to spinal cord of C5-T1 diminished gradually. The average distance from posterior median sulcus to posterolateral sulcus was 2.95 mm. The average length, width, and angle of posterior horn were 3.47 mm, 1.346 mm, and 35.98, respectively. Our study demonstrated that the spinous process and lamina of the C4 to C7 vertebrae should be resected to expose the C5-T1 when DREZ lesions are employed to treat pain after brachial plexus avulsion. The lesion-making apparatus should be inserted at an angle of 308-408, the width of lesion should be less than 1.2 mm and the lesion depth less than 3.1 mm. Deafferentation pain is a common complication of brachial plexus avulsion injuries. It is reported that the incidence of severe pain after brachial plexus avulsion is 25-90%. 1-3 In a 3-year follow-up of 122 patients of brachial plexus avulsion injuries, Wynn-Parry found that one-third reported residual pain severe enough to affect their daily activities. 4 In 1972, Sindou et al. performed the first dorsal root entry zone (DREZ) microsurgical operation by creating a lesion in the DREZ to treat spasticity and pain. 5,6 Since then, this procedure was adopted by many centers to treat intractable pain syndromes, such as brachial plexus avulsion pain, trigeminal nerve pain, post-herpetic pain, phantom pain, cancer pain involved nerve, end-zone pain post, etc. 7-11 Series of DREZ lesions can also be produced with microsurgical lasers, ultrasonic, and computer-assisted microcoagulation. [12][13][14][15][16] At present, the DREZ lesion has been accepted as one of the most effective procedures in relieving the intractable deafferentation pain in patients with brachial plexus avulsion and spinal injuries. Successful pain relief occurs in 75-80% of patients and more than 72% of patients with brachial plexus avulsion injuries obtained long-term pain relief in a 2-to10-year follow-up study. 17,18 However, the procedure of creating a lesion in the DREZ carries some complications. 19,11 If the DREZ were not completely ablated, the outcome of pain relief might not be ...

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