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Slavin KV. Commentary: The Safety and Efficacy of Dorsal Root Entry Zone Lesioning for Pain Management in Patients With Brachial Plexus Avulsion: A Systematic Review and Meta-Analysis. Neurosurgery 2024; 95:e37-e38. [PMID: 38661356 DOI: 10.1227/neu.0000000000002971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago , Illinois , USA
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Leclercq C, Mertens P. Trends and insights review. Nerve procedures in the management of upper limb spasticity. J Hand Surg Eur Vol 2024; 49:802-811. [PMID: 38534081 DOI: 10.1177/17531934241238885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
This article reviews the recent advances or nerve-oriented surgical procedures in the treatment of the spastic upper limb. The idea to intervene on the nerve is not recent, but new trends have developed in nerve surgery over the past few years, stimulating experiments and research. Specific surgical procedures involving the nerves have been described at different levels from proximal to distal: at the cervical spinal cord and the dorsal root entry zone (rhizotomy), at the level of the roots (contralateral C7 transfer) or in the peripheral nerve, within the motor trunk (selective neurectomy) or as its branches penetrate the muscles (hyperselective neurectomy). All of these neurosurgical procedures are only effective on spasticity but do not address the other deformities, such as contractures and motor deficit. Additional procedures may have to be planned in conjunction with nerve procedures to optimize outcomes.
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Affiliation(s)
| | - Patrick Mertens
- Service de Neurochirurgie fonctionnelle, Hôpital P.-Wertheimer, Hospices Civils de Lyon, Bron, France
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Vijayendra V, Bhargava D, Pridgeon M, Szylak R, Eldridge P, Osman-Farah J. Dorsal root entry zone lesioning for brachial plexus avulsion - technical evolution and long-term follow-up. Acta Neurochir (Wien) 2024; 166:241. [PMID: 38814478 DOI: 10.1007/s00701-024-06132-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Brachial plexus avulsion (BPA) injuries can cause severe deafferentation pain. This has been successfully treated with dorsal root entry zone (DREZ) lesioning. Distortions in anatomy following a BPA injury can make identifying neural structures challenging. We describe a modification to the operative technique that improves the surgical view and the advanced intraoperative neuromonitoring (IONM) employed to identify DREZ. We have analysed the long-term outcomes for pain, quality of life, and complications in patients undergoing DREZ lesioning. METHODS This is a single-centre retrospective case series including patients who underwent DREZ lesioning with IONM for brachial plexus avulsion between 2012 and 2022. Analysed data included pre- and postoperative pain (VAS), quality of life score for chronic pain, and complications. The evolution of the surgical approach is discussed. RESULTS 44 consecutive patients underwent a DREZ lesioning procedure with intraoperative monitoring and mapping. In these patients the mean VAS score improved from 8.9 (7-10) to 1.87 (0-6) (p < 0.0001) at the time of discharge. 31 patients were followed-up for more than 12 months with a mean duration of follow-up of 41 months and their results were as follows: the mean VAS improved from 9.0 (7-10) to 4.1 (0-9) (p < 0.0001) at the last follow-up and the mean QOL values improved from 3.7 (2-6) to 7.4 (4-10) (p < 0.0001). The long-term outcomes were 'good' in 39%, 'fair' in 29% and 'poor' in 32% of patients. 55% of the patients were able to stop or reduce pain medications. CONCLUSIONS Modifications of surgical technique provide better exposure of DREZ, and IONM aids in identifying DREZ in the presence of severe intra-dural changes. Long-term outcomes of DREZ lesioning indicate not only a reduction in pain but also a significant improvement in quality of life.
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Affiliation(s)
- Vishwas Vijayendra
- Departament of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, L9 7LJ, UK.
| | - Deepti Bhargava
- Departament of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, L9 7LJ, UK
| | - Michael Pridgeon
- Departament of Neurophysiology, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, L9 7LJ, UK
| | - Rafal Szylak
- Departament of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, L9 7LJ, UK
| | - Paul Eldridge
- Retired, Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, L9 7LJ, UK
| | - Jibril Osman-Farah
- Departament of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, L9 7LJ, UK
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Georgoulis G, Neromyliotis E, Sindou M. Anatomical damages in the spinal nerve roots and the spinal cord after brachial plexus injury: descriptive study from a cohort of consecutive patients who underwent DREZ-lesioning for pain-practical implications. Acta Neurochir (Wien) 2024; 166:201. [PMID: 38698241 DOI: 10.1007/s00701-024-06063-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/29/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Systematic descriptions of anatomical damage after brachial plexus injury (BPI) at the intradural level have been scarcely reported in detail. However, considering these damages, not only in the spinal nerve roots but also in the spinal cord itself, is crucial in determining the appropriate surgical approach to restore upper limb function and address refractory pain. Therefore, the authors present a descriptive study focusing on intradural findings observed during microsurgical DREZ-lesioning. METHODS This study enrolled 19 consecutive patients under the same protocol. Microsurgical observation through exposure of C4 to Th1 medullary segments allowed to describe the lesions in spinal nerve roots, meninges, and spinal cord. Electrical stimulation of the ventral roots checked the muscle responses. RESULTS Extensive damage was observed among the 114 explored roots (six roots per patient), with only 21 (18.4%) ventral (VR) and 17 (14.9%) dorsal (DR) roots retaining all rootlets intact. Damage distribution varied, with the most frequent impairments in C6 VRs (18 patients) and the least in Th1 VRs (14 patients), while in all the 19 patients for the C6 DRs (the most frequently impaired) and in 14 patients for Th1 DRs (the less impaired). C4 roots were found damaged in 12 patients. Total or partial avulsions affected 63.3% and 69.8% of DRs and VRs, respectively, while 15.8% and 14.0% of the 114 DRs and VRs were atrophic, maintaining muscle responses to stimulation in half of those VRs. Pseudomeningoceles were present in 11 patients but absent in 46% of avulsed roots. Adhesive arachnoiditis was noted in 12 patients, and dorsal horn parenchymal alterations in 10. CONCLUSIONS Knowledge of intradural lesions post-BPI helps in guiding surgical indications for repair and functional neurosurgery for pain control.
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Affiliation(s)
- George Georgoulis
- Department of Neurosurgery, General Hospital of Athens "G. Gennimatas", Mesogeion Avenue 154, 11527, Athens, Greece.
| | | | - Marc Sindou
- University of Lyon, Lyon, France
- Department of Neurosurgery, Groupe ELSAN, Clinique Bretéché, Nantes, France
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Cohen SP, Caterina MJ, Yang SY, Socolovsky M, Sommer C. Pain in the Context of Sensory Deafferentation. Anesthesiology 2024; 140:824-848. [PMID: 38470115 DOI: 10.1097/aln.0000000000004881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Pain that accompanies deafferentation is one of the most mysterious and misunderstood medical conditions. Prevalence rates for the assorted conditions vary considerably but the most reliable estimates are greater than 50% for strokes involving the somatosensory system, brachial plexus avulsions, spinal cord injury, and limb amputation, with controversy surrounding the mechanistic contributions of deafferentation to ensuing neuropathic pain syndromes. Deafferentation pain has also been described for loss of other body parts (e.g., eyes and breasts) and may contribute to between 10% and upwards of 30% of neuropathic symptoms in peripheral neuropathies. There is no pathognomonic test or sign to identify deafferentation pain, and part of the controversy surrounding it stems from the prodigious challenges in differentiating cause and effect. For example, it is unknown whether cortical reorganization causes pain or is a byproduct of pathoanatomical changes accompanying injury, including pain. Similarly, ascertaining whether deafferentation contributes to neuropathic pain, or whether concomitant injury to nerve fibers transmitting pain and touch sensation leads to a deafferentation-like phenotype can be clinically difficult, although a detailed neurologic examination, functional imaging, and psychophysical tests may provide clues. Due in part to the concurrent morbidities, the physical, psychologic, and by extension socioeconomic costs of disorders associated with deafferentation are higher than for other chronic pain conditions. Treatment is symptom-based, with evidence supporting first-line antineuropathic medications such as gabapentinoids and antidepressants. Studies examining noninvasive neuromodulation and virtual reality have yielded mixed results.
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Affiliation(s)
- Steven P Cohen
- Departments of Anesthesiology, Neurology, Physical Medicine and Rehabilitation, Psychiatry and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Departments of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Michael J Caterina
- Neurosurgery Pain Research Institute and Department of Biological Chemistry, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Su-Yin Yang
- Psychology Service, Woodlands Health, and Adjunct Faculty, Lee Kong Chian School of Medicine, Singapore
| | - Mariano Socolovsky
- Department of Neurosurgery, University of Buenos Aires, Buenos Aires, Argentina
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Slavin KV. Commentary: Combined Thermocoagulation and Mechanical Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion Pain: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e310-e311. [PMID: 36723291 DOI: 10.1227/ons.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 02/02/2023] Open
Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.,Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois, USA
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Evaluation and Management of Radiation-Induced Plexopathies. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00374-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kimoto Y, Hosomi K, Ohnishi Y, Emura T, Mori N, Nishi A, Yanagisawa T, Tani N, Oshino S, Saitoh Y, Kishima H. Tight adhesions after spinal cord stimulation observed during dorsal root entry zone lesioning for pain after spinal root avulsion: illustrative cases. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22145. [PMID: 36281477 PMCID: PMC9592961 DOI: 10.3171/case22145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/09/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients often experience strong shooting pains after spinal root avulsion. The efficacy of spinal cord stimulation (SCS) for this type of pain is inconsistent; however, dorsal root entry zone (DREZ) lesioning (DREZ-lesion) has often proven to be an effective treatment modality. The authors report two cases in which DREZ-lesion was performed to treat pain after spinal root avulsion after implantation of SCS, but the operations were challenging due to strong adhesions. OBSERVATIONS The authors present two cases of patients with pain after spinal root avulsion in whom SCS implantation was only temporarily effective. Patients complained of persistent and paroxysmal shooting pains in the upper extremities. SCS removal and DREZ-lesion were performed, but adhesions in the epidural and subdural space contacting the leads were strong, making it difficult to expose the DREZ. LESSONS Although adhesions around the spinal cord can be caused by trauma, the authors believe that in these cases, the adhesions could have been caused by the SCS leads. There are few previous reports confirming the efficacy of SCS in treating pain after spinal root avulsion; therefore, caution is required when considering SCS implantation.
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Affiliation(s)
- Yuki Kimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koichi Hosomi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan,Center for Pain Management, Osaka University Hospital, Suita, Osaka, Japan
| | - Yuichiro Ohnishi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan,Department of Neurosurgery, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Takuto Emura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Nobuhiko Mori
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan,Center for Pain Management, Osaka University Hospital, Suita, Osaka, Japan
| | - Asaya Nishi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan,Institute for Advanced Co-Creation Studies, Osaka University, Suita, Osaka, Japan
| | - Naoki Tani
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan,Center for Pain Management, Osaka University Hospital, Suita, Osaka, Japan
| | - Youichi Saitoh
- Osaka University Graduate School of Engineering Science, Toyonaka, Osaka, Japan; and ,Tokuyukai Rehabilitation Clinic, Toyonaka, Osaka, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan,Center for Pain Management, Osaka University Hospital, Suita, Osaka, Japan
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Chikama Y, Maeda A, Tanaka R, Tominaga M, Shirozu K, Yamaura K. Cervical selective nerve root injection alleviates chronic refractory pain after brachial plexus avulsion: a case report. JA Clin Rep 2022; 8:84. [PMID: 36222984 PMCID: PMC9556677 DOI: 10.1186/s40981-022-00574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background Intractable chronic pain, as well as motor, sensory, and autonomic neuropathy, significantly reduces the quality of life of brachial plexus avulsion (BPA) patients. We report the successful application of cervical selective nerve root injection (CSNRI) in a patient with BPA. Case presentation A 40-year-old man had been diagnosed with complete left BPA due to a motorcycle accident and underwent intercostal nerve transplantation at the age of 18 years and had been experiencing pain ever since. His pain increased after fracture of the left humerus, and he was referred to our pain management clinic. As his exacerbated pain was suspected to be due to peripheral nerve hypersensitivity, we performed repetitive ultrasound-guided CSNRI (3 mL of 1% mepivacaine of each) targeted C5 and 6 intervertebral foramina, and his symptoms gradually improved. Conclusions Repetitive CSNRI may help diagnose and treat BPA-associated peripheral neuropathic pain, even in patients diagnosed with BPA.
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Affiliation(s)
- Yoji Chikama
- grid.411248.a0000 0004 0404 8415Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, 812-8582 Japan
| | - Aiko Maeda
- grid.411248.a0000 0004 0404 8415Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, 812-8582 Japan
| | - Ryudo Tanaka
- grid.411248.a0000 0004 0404 8415Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, 812-8582 Japan
| | - Masachika Tominaga
- grid.411248.a0000 0004 0404 8415Operating Rooms, Kyushu University Hospital, Fukuoka, Japan
| | - Kazuhiro Shirozu
- grid.411248.a0000 0004 0404 8415Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, 812-8582 Japan
| | - Ken Yamaura
- grid.177174.30000 0001 2242 4849Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan
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Differential Activation of pERK1/2 and c-Fos Following Injury to Different Regions of Primary Sensory Neuron. Life (Basel) 2022; 12:life12050752. [PMID: 35629419 PMCID: PMC9147482 DOI: 10.3390/life12050752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 12/30/2022] Open
Abstract
Nerve injury causes hyperexcitability of the dorsal root ganglion (DRG) and spinal dorsal horn (DH) neurons, which results in neuropathic pain. We have previously demonstrated that partial dorsal rhizotomy (PDR) produced less severe pain-like behavior than chronic constriction injury (CCI) or chronic compression of DRG (CCD) and did not enhance DRG neuronal excitability. However, the mechanisms underlying such discrepancy remain unclear. This study was designed to compare the activation of phosphorylated extracellular signal-regulated kinase 1/2 (pERK1/2) in DRG and DH, and c-Fos in DH following treatments of CCI, CCD, and PDR. We confirmed that thermal hyperalgesia produced by PDR was less severe than that produced by CCI or CCD. We showed that pERK1/2 in DRG and DH was greatly activated by CCI or CCD, whereas PDR produced only transient and mild pERK1/2 activation. CCI, CCD, and PDR induced robust c-Fos expression in DH; nevertheless, c-Fos+ neurons following PDR were much fewer than that following CCI or CCD. Blocking retrograde axonal transport by colchicine proximal to the CCI injury site diminished thermal hyperalgesia and inhibited pERK1/2 and c-Fos activation. These findings demonstrate that less severe pain-like behavior produced by PDR than CCI or CCD attributes to less activation of pERK1/2 and c-Fos. Such neurochemical activation partially relies on retrograde axonal transport of certain “injury signals” from the peripheral injured site to DRG somata.
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Khalifeh JM, Lubelski D, Ochuba A, Belzberg AJ. Dorsal Root Entry Zone Lesioning for the Treatment of Pain After Brachial Plexus Avulsion Injury: 2-Dimensional Operative Video and Technical Report. Oper Neurosurg (Hagerstown) 2022; 22:e252-e258. [DOI: 10.1227/ons.0000000000000149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
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Success with dorsal root entry zone lesioning after a failed trial of spinal cord stimulation in a patient with pain due to brachial plexus avulsion. Pain Rep 2021; 6:e973. [PMID: 34841182 PMCID: PMC8613335 DOI: 10.1097/pr9.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/10/2021] [Accepted: 09/30/2021] [Indexed: 10/28/2022] Open
Abstract
Pain caused by brachial plexopathy (BP) represents a challenging clinical problem with few effective therapeutic options. Here, we present a patient with severe, painful BP after a high-impact motor vehicle accident who failed conservative treatments. A trial of cervical spinal cord stimulation was completed using multiple waveforms (tonic, BurstDR, and 10 kHz) over 14 days with only 30% to 40% pain reduction. Subsequently, he underwent dorsal root entry zone lesioning with a significant decrease in his pain 1 year later. Surgical exploration revealed extensive damage and avulsion of his cervical roots that was not observed on a previous brachial plexus magnetic resonance imaging. We discuss the etiology and diagnosis of traumatic BP, possible reasons for the failed spinal cord stimulation trial, and implications for management.
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Mongardi L, Visani J, Mantovani G, Vitali C, Ricciardi L, Giordano F, Cavallo MA, Lofrese G, D'andrea M, Roblot P, De Bonis P, Scerrati A. Long term results of Dorsal Root Entry Zone (DREZ) lesions for the treatment of intractable pain: A systematic review of the literature on 1242 cases. Clin Neurol Neurosurg 2021; 210:107004. [PMID: 34739884 DOI: 10.1016/j.clineuro.2021.107004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Different Dorsal root entry zone (DREZ) lesion techniques have been reported as effective treatment for intractable painful conditions, though with contradictory results. Overall, good results were reported especially in specific conditions, such as pain due to brachial plexus avulsion, spinal cord injuries and oncological pain management. However, data on long term results in different clinical conditions are still missing. OBJECTIVE This study aims to systematically review the pertinent literature to evaluate indications, clinical outcomes, and complications of DREZ lesion (DREZotomy), in chronic pain management. METHODS A systematic literature review was conducted according to the PRISMA statement. Papers on DREZotomy for chronic pain in cancer, brachial plexus avulsion, spinal cord injury, post herpetic neuralgia, and phantom limb pain were considered for eligibility. For each category we further identified two sub-group according to the length of follow up: medium term and long term follow up (more than 3 years) respectively. RESULTS 46 papers, and 1242 patients, were included in the present investigation. When considering long term results DREZotomy provided favorable clinical outcomes in brachial plexus avulsion and spinal cord injury, in 60.8% and 55.8% of the cases respectively. Conversely, the success rate was 35.3% in phantom limb pain and 28.2% in post herpetic neuralgia. A poor clinical outcome was reported in over than 25% of the patients suffering from phantom limb pain, post herpetic neuralgia and spinal cord injury. The mean complications rate was 23.58%. While BPA and SCI patients presented stable improvement over time, good outcomes among PHN and PLP groups dropped by - 46.2%; and - 14.7% at long term follow up respectively. CONCLUSION DREZotomy seems to be an effective treatment for chronic pain conditions, especially for brachial plexus avulsion, spinal cord injury and intractable cancer/post-radiation pain. According to the low level of evidence of the pertinent literature, further studies are strongly recommended, to better define potential benefits and limitations of this technique.
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Affiliation(s)
- Lorenzo Mongardi
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy.
| | - Jacopo Visani
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Giorgio Mantovani
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Costanza Vitali
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Luca Ricciardi
- UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, LE, Italy
| | - Flavio Giordano
- Department of Neurosurgery, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Michele Alessandro Cavallo
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | | | | | - Paul Roblot
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
| | - Pasquale De Bonis
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | - Alba Scerrati
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
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