The Indian Journal of Neurotrauma (Dec 2005)
The DREZ surgical treatment of chronic pain in traumatic paraplegia
Abstract
The Microsurgical DREZotomy, as a curative surgery in treating paraplegic pain, has been established on the basis of the functional anatomy of the Dorsal Root Entry Zone (DREZ) and aims at a lesion of the dorsal-most layers of the dorsal horn of the deafferented cord segments, shown to be involved in pain generating. According to the postulate that the long-term result of the DREZ surgery for the paraplegic pain depends on the accuracy, size and completeness of the dorsal horn lesion, we developed the lesioning technique based on the natural differences in mechanical properties between the white and gray cord substances, that allowed for the selective and safe suctioning of the dorsal horn gray substance under the visual microsurgical control. The utility, selectivity and safety of the dorsal horn suction technique has been provided by the natural mechanical properties of the cord tissue itself. The comparative results of treating paraplegic pain using two lesioning techniques are reported. The total of 38 patients with chronic neuropathic pain as the sequela of the spinal gunshot war injuries were treated using DREZ - lesioning. Twenty four of these patients were operated on using the Sindou,s Microsurgical DREZotomy technique (MDT), while 14 were operated on using the MDT modified with the dorsal horn suction as a lesioning method. A long term success in treating pain was achieved in 77 % patients operated on using the standard Microsurgical DREZotomy. A successful long-term pain relief was achieved in 85% patients operated on using the dorsal horn suctioning. Our results implied that the size and the shape, i.e. the completeness of the DREZ lesion might play an important role in providing the better long-term result of the DREZ surgery for the paraplegic pain treatment. Intermittent rhythm and defined unilateral or bilateral pain territory were the most significant features of the pain syndrome that was successfully cured by the DREZ surgery.
