Results of Selective Posterior Rhizotomy in the Treatment of Painful and Spastic Paraplegia Secondary to Multiple Sclerosis

Sindou, Marc; Millet, M. F.; Mortamais, J.; Eyssette, M

doi:10.1159/000101621

Cited by 14 publications

(12 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One year after this procedure, the patient continued to have good control of spasticity. This is consistent with European studies that report a marked reduction of spasticity in five of six patients with severe multiple sclerosis in one series (13) and twelve of fifteen patients in another series (14). No return of spasticity was noted after follow-up of 6-26 months (13).…”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

The Effect of Dorsal Rootlet Rhizotomy on Function and Spasticity in a Patient with Multiple Sclerosis

Meythaler

Plucinski

Cross

et al. 1992

Neurorehabilitation and Neural Repair

View full text Add to dashboard Cite

Selective dorsal rootlet rhizotomy (SDRR) permits a more controlled step-wise approach to the treatment of spasticity. This procedure allows one to modulate the afferent input to the spinal cord without affecting the efferent output to the anterior horn cell. SDRR allows for a selection of the motor levels affected by spasticity while preserving others. Reported is a case in which SDRR was performed to improve function and reduce spasticity in a patient with multiple sclerosis. As a result of the procedure, the patient's muscle tone was reduced but not ablated, allowing for self-catheterizations, improved sitting posture, transfers, and a gain of at least one full muscle grade in voluntary motor control of the lower extremities. Selective dorsal rootlet rhizotomy offers an alternative to other more radical surgical procedures in modulating spasticity in multiple sclerosis when medical management is not sufficient.

show abstract

Section: Discussionsupporting

confidence: 92%

“…No return of spasticity was noted after follow-up of 6-26 months (13). Although our patient reported no sensory problems, up to 87% of MS patients experienced some sensory loss after selective dorsal rootlet rhizotomy (14).…”

Section: Discussionmentioning

confidence: 49%

The Effect of Dorsal Rootlet Rhizotomy on Function and Spasticity in a Patient with Multiple Sclerosis

Meythaler

Plucinski

Cross

et al. 1992

Neurorehabilitation and Neural Repair

View full text Add to dashboard Cite

show abstract

“…17,28,29 An additional study focused specifically on the results of SDR in patients with spasticity from this cause. 32 This series was composed of 15 patients with a diagnosis of MS who underwent SDR between 1974 and 1981. Thirteen of the patients were women, the duration between diagnosis of MS and surgery ranged from 6 to 30 years (average 12 years), and age at surgery ranged from 31 to 58 years old.…”

Section: Spasticity From Msmentioning

confidence: 99%

Selective dorsal rhizotomy for spasticity not associated with cerebral palsy: reconsideration of surgical inclusion criteria

Gump

Mutchnick

Moriarty

2013

FOC

View full text Add to dashboard Cite

Children with spastic diplegia from cerebral palsy (CP) experience measurable improvement in their spasticity and motor function following selective dorsal rhizotomy (SDR). The role of this operation in the treatment of other spasticity causes is less well defined. A literature review was undertaken to survey outcomes from SDRs performed outside the CP population. Multiple sclerosis was the most common diagnosis found, accounting for 74 of 145 patients described. Selective dorsal rhizotomies have also been reported in patients with traumatic brain and spinal cord injuries, ischemic and hemorrhagic stroke, neurodegenerative disease, hypoxic encephalopathy, and other causes of spasticity. Outcomes from surgery are generally described as favorable, although postoperative assessments and follow-up times are not standardized across reports. Long-term outcomes are sparsely reported. Larger numbers of patients and more detailed outcomes data have the potential to form a basis for expanding the inclusion criteria for SDR.

show abstract

“…As early as 1973, MDT was performed for the treatment of pain in disabling hyperspasticity 26,51,[58][59][60][61][62] with resulting diminished muscular tone in the operated areas. 4,27 The antispastic effects can be explained by the fact that MDT interrupts the afferent components of the myotatic (monosynaptic) and the nociceptive (polysynaptic) reflexes and so deprives the somatosensory relays of the dorsal horn of excitatory inputs.…”

Section: Pain Accompanying Disabling Hyperspastic Statesmentioning

confidence: 99%

Surgery in the Dorsal Root Entry Zone for Pain

Sindou

Mertens²

2004

Seminars in Neurosurgery

View full text Add to dashboard Cite

The dorsal root entry zone (and dorsal horn)-which is the first important level of modulation for pain sensation-can be a neurosurgical target to treat resistant pain. Lesioning techniques include microsurgical coagulation, radiofrequency thermocoagulation, laser beam or ultrasound lesion maker. Indications are (1) malignant pain in patients with long life expectancy and cancer that is limited in extent (such as in Pancoast-Tobias syndrome); (2) persistent neuropathic pain that is due to (a) brachial plexus injuries, especially those with avulsion, (b) spinal cord lesions (predominantly in the conus medullaris), especially the pain corresponding to segmental lesions (pain below the lesion is not favorably influenced), (c) segmental pain caused by lesions in the cauda equina, (d) peripheral nerve injuries, amputation, or herpes zoster, when the predominant component of pain is of the paroxysmal type and/or corresponds to provoked allodynia or hyperalgesia; and (3) disabling hyperspastic states with pain.KEYWORDS: Cancer pain, neuropathic pain, spasticity, dorsal root entry zone, neurosurgery for pain Objectives: Upon completion of this article, the reader should be able to: (1) understand the functional anatomy of the DREZ; (2) summarize the various surgical lesioning techniques for performing therapeutic DREZ lesions; and (3) list main indications for DREZ lesioning for patients affected with disabling pain.Until the mid-20th century, pain pathways were defined as the pathways whose interruption produced analgesia or alleviation of acute pain, that is, the sensory nerves, the dorsal roots and ganglia, the neo-and paleoreticulothalamic tracts, the relay areas within the thalamus, and cortical representation(s). 1 In the 1960s, gate control theory 2 drew neurosurgeons' attention to the dorsal horn as the first important level of modulation for pain sensation. This area was then considered a possible target for pain surgery through spinal cord stimulation 3 and ablative surgery in the dorsal root entry zone (DREZ). 4,5 The DREZ was defined as an entity including the central portion of the dorsal rootlet, the most medial part of the tract of Lissauer, and the most dorsal layers (I to V) of the dorsal horn, where the afferent fibers synapse with the cells of the sensory spinoreticulothalamic ascending pathways (Fig. 1 left).The first attempts at DREZ lesioning were performed in March 1972 at the Neurological Institute Pierre Wertheimer in Lyon for localized malignant pain (Pancoast-Tobias syndrome), using microsurgical techniques to perform a destructive lesion in the ventrolateral region of the DREZ. Because the first results were encouraging, the procedure was attempted

show abstract

Results of Selective Posterior Rhizotomy in the Treatment of Painful and Spastic Paraplegia Secondary to Multiple Sclerosis

Cited by 14 publications

References 2 publications

The Effect of Dorsal Rootlet Rhizotomy on Function and Spasticity in a Patient with Multiple Sclerosis

The Effect of Dorsal Rootlet Rhizotomy on Function and Spasticity in a Patient with Multiple Sclerosis

Selective dorsal rhizotomy for spasticity not associated with cerebral palsy: reconsideration of surgical inclusion criteria

Surgery in the Dorsal Root Entry Zone for Pain

Contact Info

Product

Resources

About