Spinal cord injury below-level neuropathic pain relief with dorsal root entry zone microcoagulation performed caudal to level of complete spinal cord transection
| Autor: | Scott Falci, Charlotte Indeck, Dave Barnkow |
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| Rok vydání: | 2018 |
| Předmět: |
Dorsum
Central pain Male Sympathetic nervous system Microsurgery Models Neurological Synaptic Transmission Neurosurgical Procedures 03 medical and health sciences 0302 clinical medicine Spinal cord transection Neural Pathways Medicine Humans Pain Management Spinal cord injury Spinal Cord Injuries 030222 orthopedics business.industry General Medicine Middle Aged Fft fast fourier transform Spinal cord medicine.disease medicine.anatomical_structure Spinal Cord Anesthesia Neuropathic pain Neuralgia business Spinal Nerve Roots 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Journal of neurosurgery. Spine. 28(6) |
| ISSN: | 1547-5646 |
| Popis: | OBJECTIVESurgically created lesions of the spinal cord dorsal root entry zone (DREZ) to relieve central pain after spinal cord injury (SCI) have historically been performed at and cephalad to, but not below, the level of SCI. This study was initiated to investigate the validity of 3 proposed concepts regarding the DREZ in SCI central pain: 1) The spinal cord DREZ caudal to the level of SCI can be a primary generator of SCI below-level central pain. 2) Neuronal transmission from a DREZ that generates SCI below-level central pain to brain pain centers can be primarily through sympathetic nervous system (SNS) pathways. 3) Perceived SCI below-level central pain follows a unique somatotopic map of DREZ pain-generators.METHODSThree unique patients with both intractable SCI below-level central pain and complete spinal cord transection at the level of SCI were identified. All 3 patients had previously undergone surgical intervention to their spinal cords—only cephalad to the level of spinal cord transection—with either DREZ microcoagulation or cyst shunting, in failed attempts to relieve their SCI below-level central pain. Subsequent to these surgeries, DREZ lesioning of the spinal cord solely caudal to the level of complete spinal cord transection was performed using electrical intramedullary guidance. The follow-up period ranged from 1 1/2 to 11 years.RESULTSAll 3 patients in this study had complete or near-complete relief of all below-level neuropathic pain. The analyzed electrical data confirmed and enhanced a previously proposed somatotopic map of SCI below-level DREZ pain generators.CONCLUSIONSThe results of this study support the following hypotheses. 1) The spinal cord DREZ caudal to the level of SCI can be a primary generator of SCI below-level central pain. 2) Neuronal transmission from a DREZ that generates SCI below-level central pain to brain pain centers can be primarily through SNS pathways. 3) Perceived SCI below-level central pain follows a unique somatotopic map of DREZ pain generators. |
| Databáze: | OpenAIRE |
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