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Journal articles on the topic 'Dorsal root entry zone'

Author: Grafiati

Published: 4 June 2021

Last updated: 1 February 2022

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1

Spaic, Milan, David Houlden, and Michael Schwartz. "Minimally Invasive Dorsal Root Entry Zone Operation." Neurosurgery 65, no. 2 (August 1, 2009): 416. http://dx.doi.org/10.1227/01.neu.0000358719.72315.26.

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2

Moossy, John J., and Blaine S. Nashold Jr. "Dorsal Root Entry Zone Lesions for Conus medullaris Root Avulsions." Stereotactic and Functional Neurosurgery 51, no. 2-5 (1988): 198–205. http://dx.doi.org/10.1159/000099963.

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3

Iacono, R. P., A. N. Guthkelch, and M. V. Boswell. "Dorsal Root Entry Zone Stimulation for Deafferentation Pain." Stereotactic and Functional Neurosurgery 59, no. 1-4 (1992): 56–61. http://dx.doi.org/10.1159/000098918.

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4

Saris, Stephen C., José F. S. Vieira, and Blaine S. Nashold Jr. "Dorsal Root Entry Zone Coagulation for Intractable Sciatica." Stereotactic and Functional Neurosurgery 51, no. 2-5 (1988): 206–11. http://dx.doi.org/10.1159/000099964.

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5

Ren, Jian, Chuan He, Tao Hong, Xiaoyu Li, Yongjie Ma, Jiaxing Yu, Feng Ling, and Hongqi Zhang. "Anterior to Dorsal Root Entry Zone Myelotomy (ADREZotomy)." SPINE 43, no. 17 (September 2018): E1024—E1032. http://dx.doi.org/10.1097/brs.0000000000002607.

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6

Kumagai, Y., K. Shimoji, T. Honma, S. Uchiyama, B. Ishijima, T. Hokari, H. Fujioka, S. Fukuda, and E. Ohama. "Problems related to dorsal root entry zone lesions." Acta Neurochirurgica 115, no. 3-4 (September 1992): 71–78. http://dx.doi.org/10.1007/bf01406361.

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7

Saris, Stephen C., Robert P. Iacono, and Blaine S. Nashold. "Dorsal root entry zone lesions for post-amputation pain." Journal of Neurosurgery 62, no. 1 (January 1985): 72–76. http://dx.doi.org/10.3171/jns.1985.62.1.0072.

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✓ Chronic pain following an amputation may involve the stump, the phantom limb, or both. Operations such as rhizotomy, cordotomy, stump revision, and dorsal column stimulation have been unsuccessful in treating this condition. This study evaluates the effectiveness of dorsal root entry zone (DREZ) coagulation for this pain problem. The authors studied 22 patients with amputations due to trauma, gangrene, or cancer. All developed post-amputation pain, underwent a DREZ procedure, and were followed from 6 months to 4 years after surgery. Overall, only eight (36%) of these 22 patients had pain relief. However, good results were obtained in six (67%) of nine patients with phantom pain alone, and in five (83%) of six patients with traumatic amputations associated with root avulsion. Poor results were obtained in patients with both phantom and stump pain, or stump pain alone. The DREZ procedure has a limited, but definite, place in the treatment of post-amputation pain.

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8

Lunsford, L. Dade, and Marvin H. Bennett. "Evoked-Potential Monitoring during Dorsal Root Entry Zone Surgery." Stereotactic and Functional Neurosurgery 53, no. 4 (1989): 233–46. http://dx.doi.org/10.1159/000099539.

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9

Bennett, Marvin H., L. Dade Lunsford, Osman Akin, and A. Julio Martinez. "Evoked-Potential Monitoring during Dorsal Root Entry Zone Surgery." Stereotactic and Functional Neurosurgery 53, no. 4 (1989): 247–60. http://dx.doi.org/10.1159/000099540.

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10

Nashold Jr., Blaine S. "Neurosurgical Technique of the Dorsal Root Entry Zone Operation." Stereotactic and Functional Neurosurgery 51, no. 2-5 (1988): 136–45. http://dx.doi.org/10.1159/000099956.

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11

Iacono, R. P., M. L. Aguirre, and B. S. Nashold Jr. "Anatomic Examination of Human Dorsal Root Entry Zone Lesions." Stereotactic and Functional Neurosurgery 51, no. 2-5 (1988): 225–29. http://dx.doi.org/10.1159/000099967.

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12

TORRENS, G. STRANJALIS &. M. "Dorsal root entry zone lesion performed with Nd:YAG laser." British Journal of Neurosurgery 11, no. 3 (January 1997): 238–40. http://dx.doi.org/10.1080/02688699746311.

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13

Sindou, Marc, and Patrick Mertens. "Surgery in the Dorsal Root Entry Zone for Pain." Seminars in Neurosurgery 15, no. 02/03 (October 25, 2004): 221–32. http://dx.doi.org/10.1055/s-2004-835710.

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14

Golding, Jon, Derryck Shewan, and James Cohen. "Maturation of the mammalian dorsal root entry zone- from entry to no entry." Trends in Neurosciences 20, no. 7 (July 1997): 303–9. http://dx.doi.org/10.1016/s0166-2236(96)01044-2.

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15

Collins, Andrew, Ahmed Ibrahim, Daqing Li, Modinat Liadi, and Ying Li. "Reconstruction of the Damaged Dorsal Root Entry Zone by Transplantation of Olfactory Ensheathing Cells." Cell Transplantation 28, no. 9-10 (July 4, 2019): 1212–19. http://dx.doi.org/10.1177/0963689719855938.

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The dorsal root entry zone is often used in research to examine the disconnection between the central and peripheral parts of the nervous system which occurs following injury. Our laboratory and others have used transplantation of olfactory ensheathing cells (OECs) to repair experimental spinal cord injuries. We have previously used a four dorsal root (C6–T1) transection model to show that transplantation of OECs can reinstate rat forelimb proprioception in a climbing task. Until now, however, we have not looked in detail at the anatomical interaction between OECs and the peripheral/central nervous system regions which form the transitional zone. In this study, we compared short- and long-term OEC survival and their interaction with the surrounding dorsal root tissue. We reveal how transplanted OECs orient toward the spinal cord and allow newly formed axons to travel across into the dorsal horn of the spinal cord. Reconstruction of the dorsal root entry zone was supported by OEC ensheathment of axons at the injured site and also at around 3 mm further away at the dorsal root ganglion. Quantitative analysis revealed no observable difference in dorsal column axonal loss between transplanted and control groups of rats.

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16

Konrad, Peter. "Dorsal Root Entry Zone Lesion, Midline Myelotomy and Anterolateral Cordotomy." Neurosurgery Clinics of North America 25, no. 4 (October 2014): 699–722. http://dx.doi.org/10.1016/j.nec.2014.07.010.

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17

Balamurali, Gopalakrishnan. "Dorsal Root Entry Zone Operation for Brachial Plexus Neuropathic Pain." Journal of Spinal Surgery 5, no. 4 (2018): 155–61. http://dx.doi.org/10.5005/jp-journals-10039-1191.

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18

Powers, Stephen K., Nicholas M. Barbaro, and Robert M. Levy. "Pain Control with Laser-Produced Dorsal Root Entry Zone Lesions." Stereotactic and Functional Neurosurgery 51, no. 2-5 (1988): 243–54. http://dx.doi.org/10.1159/000099969.

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19

Koeppen, Arnulf H., Alyssa B. Becker, Jiang Qian, Benjamin B. Gelman, and Joseph E. Mazurkiewicz. "Friedreich Ataxia: Developmental Failure of the Dorsal Root Entry Zone." Journal of Neuropathology & Experimental Neurology 76, no. 11 (October 3, 2017): 969–77. http://dx.doi.org/10.1093/jnen/nlx087.

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20

Xiang, Jian-Ping, Xiao-Ling Liu, Yang-Bing Xu, Jian-Yun Wang, and Jun Hu. "Microsurgical anatomy of dorsal root entry zone of brachial plexus." Microsurgery 28, no. 1 (January 2008): 17–20. http://dx.doi.org/10.1002/micr.20438.

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21

Rasskazoff, Serge, and Anthony M. Kaufmann. "Ventrolateral Partial Dorsal Root Entry Zone Rhizotomy for Occipital Neuralgia." Pain Research and Management 10, no. 1 (2005): 43–45. http://dx.doi.org/10.1155/2005/784750.

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OBJECTIVE AND IMPORTANCE: Medically refractory occipital neuralgia (ON) has been treated with a variety of neuroablative procedures. The present case report supports the effectiveness of ventrolateral partial rhizotomy (pVL-DREZ) of the C1 to C3 cervical dorsal roots, a relatively unknown procedure.CLINICAL PRESENTATION: A 46-year-old woman had a 14-month history of severe right-sided ON. Multiple trials of medical treatments, nerve blocks and local steroid injections had failed. Her daily opioid requirements had escalated to include frequent injections in addition to prescribed oral opiates.INTERVENTION AND RESULTS: A pVL-DREZ at the right C1 to C3 level was performed through a C1 laminectomy and C2 right laminotomy. The ipsilateral upper cervical dorsal roots were exposed and a 1 mm deep incision was made at a 45° angle to the sagittal midline at the ventrolateral aspect of each dorsal rootlet entry. The patient experienced postoperative opioid withdrawal seizure and transient disequilibrium for two weeks. Touch sensation was preserved and complete abolition of ON over a four year follow-up was achieved.CONCLUSION: The pVL-DREZ procedure provided complete pain relief for the patient and avoided the potential complications often encountered with other destructive interventions. pVL-DREZ should be considered among the available options for the treatment of refractory ON.

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22

Fazl, Mahmood, and David A. Houlden. "Dorsal root entry zone localization using direct spinal cord stimulation: an experimental study." Journal of Neurosurgery 82, no. 4 (April 1995): 592–94. http://dx.doi.org/10.3171/jns.1995.82.4.0592.

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✓ Direct spinal cord stimulation and recording was performed in five dogs to identify the dorsal root entry zone (DREZ) and long tracts within the dorsal and dorsolateral spinal cord using electrophysiological mapping techniques. Intrathecal recordings were obtained from sites distal to the site of stimulation. Conduction velocity in the fastest conducting fibers was higher following low-intensity stimulation of the dorsolateral spinal cord than after dorsal spinal cord stimulation. The evoked response was larger following dorsolateral than dorsal spinal cord stimulation at a specific stimulus intensity. This technique is useful in identifying the DREZ using electrophysiological criteria alone.

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23

Zhang, Xinyu, Xuenong Bo, Patrick N. Anderson, A. Robert Lieberman, and Yi Zhang. "Distribution and expression of tissue inhibitors of metalloproteinase in dorsal root entry zone and dorsal column after dorsal root injury." Journal of Neuroscience Research 84, no. 2 (2006): 278–90. http://dx.doi.org/10.1002/jnr.20892.

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24

Sindou, Marc P., and Patrick Mertens. "Surgery in the Dorsal Root Entry Zone for Spasticity in Adults." Operative Techniques in Neurosurgery 7, no. 3 (September 2004): 157–62. http://dx.doi.org/10.1053/j.otns.2005.01.003.

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25

Nashold Jr., Blaine S., Amr El-Naggar, Mawaffak Abdulhak, Janice Ovelmen-Levitt, and Eric Cosman. "Trigeminal Nucleus Caudalis Dorsal Root Entry Zone: A New Surgical Approach." Stereotactic and Functional Neurosurgery 59, no. 1-4 (1992): 45–51. http://dx.doi.org/10.1159/000098916.

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26

Saris, Stephen C., Robert P. Iacono, and Blaine S. Nashold Jr. "Successful Treatment of Phantom Pain with Dorsal Root Entry Zone Coagulation." Stereotactic and Functional Neurosurgery 51, no. 2-5 (1988): 188–97. http://dx.doi.org/10.1159/000099962.

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27

Husain, Aatif M., Sharon L. Elliott, and John P. Gorecki. "Neurophysiological Monitoring for the Nucleus Caudalis Dorsal Root Entry Zone Operation." Neurosurgery 50, no. 4 (April 1, 2002): 822–28. http://dx.doi.org/10.1097/00006123-200204000-00025.

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28

Kirazlı, Özlem, Necati Tatarlı, Bülent Güçlü, Davut Ceylan, İbrahim Ziyal, Evren Keleş, and Safiye Çavdar. "Anatomy of the spinal dorsal root entry zone: its clinical significance." Acta Neurochirurgica 156, no. 12 (October 21, 2014): 2351–58. http://dx.doi.org/10.1007/s00701-014-2252-0.

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29

Pagnil, C. A., R. Giardulli, R. Villani, and G. De Benedittis. "Dorsal root entry zone (DREZ) lesions for central and deafferentation pain." Pain 30 (1987): S127. http://dx.doi.org/10.1016/0304-3959(87)91325-x.

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30

Samii, Madjid, Steffani Bear-Henney, Wolf Lüdemann, Marcos Tatagiba, and Ulrike Blömer. "Treatment of Refractory Pain after Brachial Plexus Avulsion with Dorsal Root Entry Zone Lesions." Neurosurgery 48, no. 6 (June 1, 2001): 1269–77. http://dx.doi.org/10.1097/00006123-200106000-00016.

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Abstract OBJECTIVE Significant numbers of patients experience intractable pain after brachial plexus root avulsions. Medications and surgical procedures such as amputation of the limb are often not successful in pain treatment. METHODS Forty-seven patients with intractable pain after traumatic cervical root avulsions were treated with dorsal root entry zone coagulation between 1980 and 1998. The dorsal root entry zone coagulation procedure was performed 4 months to 12 years after the trauma, and patients were monitored for up to 18 years (average follow-up period, 14 yr). RESULTS Immediately after surgery, 75% of patients experienced significant pain reduction; this value was reduced to 63% during long-term follow-up monitoring. Nine patients experienced major complications, including subdural hematomas (n = 2) and motor weakness of the lower limb (n = 7). Improved coagulation electrodes with thermistors that could produce smaller and more-accurate lesion sizes, which were introduced in 1989, significantly reduced the number of complications. CONCLUSION Central deafferentation pain that persists and becomes intractable among patients with traumatic cervical root avulsions has been difficult to treat in the past. Long-term follow-up monitoring of patients who underwent the dorsal root entry zone coagulation procedure in the cervical cord indicated that long-lasting satisfactory relief is possible for the majority of individuals, with acceptable morbidity rates.

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31

Guberinic, Alis, Veerle Souverein, Ruben Volkers, Anne-Marie van Cappellen van Walsum, Kris CP Vissers, Jeroen Mollink, and Dylan JHA Henssen. "Mapping the trigeminal root entry zone and its pontine fibre distribution patterns." Cephalalgia 40, no. 14 (September 22, 2020): 1645–56. http://dx.doi.org/10.1177/0333102420959796.

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Introduction Recently, an additional trigeminothalamic tract – the dorsal trigeminothalamic tract – has been described in human brainstems by our group next to the known ventral trigeminothalamic tract. As various elements of the trigeminal system are known to be organised in a somatotopic fashion, the question arose whether the fibres within the trigeminal root show specific distributions patterns in their contribution to the ventral trigeminothalamic tract and dorsal trigeminothalamic tract specifically. Methods This study investigated the arrangement of the fibres in the trigeminal root by combining various imaging methods in the pons of 11 post-mortem specimens. The pons were investigated by polarised light imaging (PLI) (n = 4; to quantify fibre orientation; 100 µm interslice distance), histochemical staining methods (n = 3; to visualise the internal myeloarchitecture; 60 µm) and ultra-high field, post-mortem magnetic resonance imaging (MRI) (n = 4; for tractography; 500 µm interslice distance). Results This study shows that the fibres, from the point where the trigeminal root enters the brainstem, are distinctly arranged by their contribution to the ventral trigeminothalamic tract and dorsal trigeminothalamic tract. This finding is supported by both post-mortem, ultra-high dMRI and different light microscopy techniques. Conclusion The data from this study suggest that the fibres in the superior half of the root contribute mainly to the ventral trigeminothalamic tract, whereas the fibres in the inferior half mainly contribute to the dorsal trigeminothalamic tract. Such a somatotopic organisation could possibly create new insights into the anatomical origin of trigeminal neuralgia and the clinical relevance of this somatotopic organisation should therefore be further explored.

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32

Takai, Keisuke, and Makoto Taniguchi. "Modified dorsal root entry zone lesioning for pain relief in cervical root avulsion injury." Neurosurgical Focus: Video 3, no. 2 (October 2020): V11. http://dx.doi.org/10.3171/2020.7.focvid2020.

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Neuropathic pain in the upper extremity due to cervical root avulsion injury is refractory to medical treatments. Superficial layers in the posterior horn of spinal gray matter, including the substantia gelatinosa, are the main target of dorsal root entry zone (DREZ) lesioning, which has been the most effective surgical treatment for the relief of intractable pain; however, residual pain and a decrease in pain relief during the long-term follow-up period have been reported. Based on pain topography in the most recent basic studies, the conventional DREZ lesioning procedure was modified to improve clinical outcomes.The video can be found here: https://youtu.be/PyaAGmAE7Og

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33

Zhang, Y., K. Tohyama, J. K. Winterbottom, N. S. K. Haque, M. Schachner, A. R. Lieberman, and P. N. Anderson. "Correlation between Putative Inhibitory Molecules at the Dorsal Root Entry Zone and Failure of Dorsal Root Axonal Regeneration." Molecular and Cellular Neuroscience 17, no. 3 (March 2001): 444–59. http://dx.doi.org/10.1006/mcne.2000.0952.

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34

Schlachetzki, Johannes C. M., Donald P. Pizzo, Debbi A. Morrissette, and Jürgen Winkler. "Intracerebroventricular Administration of Nerve Growth Factor Induces Gliogenesis in Sensory Ganglia, Dorsal Root, and within the Dorsal Root Entry Zone." BioMed Research International 2014 (2014): 1–9. http://dx.doi.org/10.1155/2014/704259.

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Previous studies indicated that intracerebroventricular administration of nerve growth factor (NGF) leads to massive Schwann cell hyperplasia surrounding the medulla oblongata and spinal cord. This study was designed to characterize the proliferation of peripheral glial cells, that is, Schwann and satellite cells, in the trigeminal ganglia and dorsal root ganglia (DRG) of adult rats during two weeks of NGF infusion using bromodeoxyuridine (BrdU) to label dividing cells. The trigeminal ganglia as well as the cervical and lumbar DRG were analyzed. Along the entire neuraxis a small number of dividing cells were observed within these regions under physiological condition. NGF infusion has dramatically increased the generation of new cells in the neuronal soma and axonal compartments of sensory ganglia and along the dorsal root and the dorsal root entry zone. Quantification of BrdU positive cells within sensory ganglia revealed a 2.3- to 3-fold increase in glial cells compared to controls with a similar response to NGF for the different peripheral ganglia examined. Immunofluorescent labeling with S100βrevealed that Schwann and satellite cells underwent mitosis after NGF administration. These data indicate that intracerebroventricular NGF infusion significantly induces gliogenesis in trigeminal ganglia and the spinal sensory ganglia and along the dorsal root entry zone as well as the dorsal root.

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35

Yamamoto, Yu, Masahito Hara, Yasuhiro Nakajima, Yusuke Nishimura, Daisuke Umebayashi, Shoichi Haimoto, and Toshihiko Wakabayashi. "Dorsal Root Entry Zone Approach for Surgery of Intramedullary Spinal Cord Tumor." Spinal Surgery 28, no. 2 (2014): 198–200. http://dx.doi.org/10.2531/spinalsurg.28.198.

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36

Nashold Jr., Blaine S. "Introduction to Second International Symposium on Dorsal Root Entry Zone (DREZ) Lesions." Stereotactic and Functional Neurosurgery 51, no. 2-5 (1988): 76–77. http://dx.doi.org/10.1159/000099950.

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37

Ishijima, Buichi, Koki Shimoji, Hiroyuki Shimizu, Hiroshi Takahashi, and Ichiro Suzuki. "Lesions of Spinal and Trigeminal Dorsal Root Entry Zone for Deafferentation Pain." Stereotactic and Functional Neurosurgery 51, no. 2-5 (1988): 175–87. http://dx.doi.org/10.1159/000099961.

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38

Kanpolat, Yucel, Hakan Tuna, Melih Bozkurt, and Atilla Halil Elhan. "Spinal and Nucleus Caudalis Dorsal Root Entry Zone Operations for Chronic Pain." Operative Neurosurgery 62, suppl_1 (March 1, 2008): ONS235—ONS244. http://dx.doi.org/10.1227/01.neu.0000317398.93218.e0.

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Abstract Objective: Dorsal root entry zone (DREZ) operations came into medical practice after the demonstration of increased electrical activity in the dorsal horn of the spinal cord and brainstem in patients with deafferentation of the central nervous system after injury to these areas. The aim of the study was to describe the technique and the effectiveness of spinal DREZ and nucleus caudalis (NC) DREZ operations, which may be the treatments of choice in unique chronic pain conditions that do not respond to medical therapy or any other surgical methods. Methods: Fifty-five patients (44 spinal, 11 NC DREZ) underwent 59 (48 spinal, 11 NC DREZ) operations. There were 44 men and 11 women with a mean age of 46.4 years (range, 24–74 yr). The mean follow-up period was 72 months (range, 6 mo–20 yr). Follow-up assessments were performed with clinical examination on the first day and in the sixth and twelfth months postoperatively. Patients' pain scores and Karnofsky Performance Scale scores were also evaluated pre- and postoperatively. Results: The initial success rates for spinal and NC DREZotomy procedures were 77 and 72.5%, respectively. In the spinal DREZotomy group, mortality occurred in one patient (2.2%). There were two cases of transient muscle weakness (4.4%) and two of cerebrospinal fluid fistulae (4.4%). In the NC DREZotomy group, mortality occurred in one patient (9%). There were two cases of transient ataxia (18%) and two of transient hemiparesis (18%). Conclusion: Spinal and trigeminal NC DREZ operations are effective in the treatment of intractable pain syndromes, especially in traumatic brachial plexus avulsions, segmental pain after spinal cord injury, postherpetic neuralgia, topographically limited cancer pain, and atypical facial pain.

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39

Levy, W. J., C. Gallo, and C. Watts. "Comparison of laser and radiofrequency dorsal root entry zone lesions in cats." Neurosurgery 16, no. 3 (March 1985): 327???30. http://dx.doi.org/10.1097/00006123-198503000-00008.

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40

Sandwell, Stephen E., Amr O. El-Naggar, G. Stephen Nettleton, and Robert D. Acland. "Trigeminal Nucleus Caudalis Anatomy: Guidance for Radiofrequency Dorsal Root Entry Zone Lesioning." Stereotactic and Functional Neurosurgery 88, no. 5 (2010): 269–76. http://dx.doi.org/10.1159/000316758.

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41

Ramer, Matt S., Ishwari Duraisingam, John V. Priestley, and Stephen B. McMahon. "Two-Tiered Inhibition of Axon Regeneration at the Dorsal Root Entry Zone." Journal of Neuroscience 21, no. 8 (April 15, 2001): 2651–60. http://dx.doi.org/10.1523/jneurosci.21-08-02651.2001.

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42

Levy, Walter J., Catherine Gallo, and Clark Watts. "Comparison of Laser and Radiofrequency Dorsal Root Entry Zone Lesions in Cats." Neurosurgery 16, no. 3 (March 1985): 327–30. http://dx.doi.org/10.1227/00006123-198503000-00008.

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43

Samreen, Naziya, and William A. Friedman. "Nucleus Caudalis Dorsal Root Entry Zone Lesions: A Clinical-Radiographic Case Report." Stereotactic and Functional Neurosurgery 87, no. 5 (2009): 314–21. http://dx.doi.org/10.1159/000235803.

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44

Thomas, D. G. T. "Brachial plexus injury: deafferentation pain and dorsal root entry zone (DREZ) coagulation." Clinical Neurology and Neurosurgery 95 (1993): 48–49. http://dx.doi.org/10.1016/0303-8467(93)90035-f.

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45

Kuroda, R., J. Nakatani, and M. Kitano. "Experimental anatomical consideration on dorsal root entry zone lesion for pain relief." Pain 30 (1987): S127. http://dx.doi.org/10.1016/0304-3959(87)91326-1.

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46

Campbell, J. A., and J. B. Miles. "Intraoperative identification of the dorsal root entry zone using somatosensory evoked potentials." Pain 30 (1987): S187. http://dx.doi.org/10.1016/0304-3959(87)91445-x.

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47

Young, Jacob N., Blaine S. Nashold, and Eric R. Cosman. "A new insulated caudalis nucleus DREZ electrode." Journal of Neurosurgery 70, no. 2 (February 1989): 283–84. http://dx.doi.org/10.3171/jns.1989.70.2.0283.

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48

Fazl, Mahmood, David A. Houlden, and Zelma Kiss. "Spinal cord mapping with evoked responses for accurate localization of the dorsal root entry zone." Journal of Neurosurgery 82, no. 4 (April 1995): 587–91. http://dx.doi.org/10.3171/jns.1995.82.4.0587.

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✓ Direct spinal cord stimulation and recording techniques were used intraoperatively to localize the dorsal root entry zone (DREZ) in four patients with brachial plexus avulsion and severe intractable pain. The spinal cord was stimulated by a cordotomy needle placed on the pia-arachnoid at the DREZ or the dorsal or dorsolateral aspect of the spinal cord. Recordings were obtained from a subdural silver ball electrode placed rostral or caudal to the stimulation site. Spinal cord conduction velocity was significantly faster following dorsolateral stimulation than dorsal stimulation (mean = 66 and 45 m/sec respectively). The spinal cord evoked potential was significantly larger in amplitude following dorsolateral stimulation than dorsal stimulation at a specific stimulus intensity. Stimulation at the DREZ failed to evoke a response. These neurophysiological phenomena helped to accurately localize the DREZ before DREZ lesioning was undertaken. There were no untoward neurological deficits related to the DREZ lesions and all patients had satisfactory pain relief following the procedure. Intraoperative spinal cord mapping facilitates accurate DREZ localization when the DREZ cannot be visually identified.

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49

Rossitch, Eugene, M. Abdulhak, Janice Ovelmen-Levitt, M. Levitt, and Blaine S. Nashold. "The expression of deafferentation dysesthesias reduced by dorsal root entry zone lesions in the rat." Journal of Neurosurgery 78, no. 4 (April 1993): 598–602. http://dx.doi.org/10.3171/jns.1993.78.4.0598.

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✓ Extensive longitudinal lesions of the dorsal root entry zone (DREZ) are effective in relieving some chronic deafferentation pain in humans. A deafferentation syndrome follows C5—T2 dorsal root ganglionectomies in rats. The syndrome consists of biting and scratching the completely and partially denervated limb areas, respectively. This study examines the effect of DREZ lesions on the deafferentation syndrome in the rat. Of 37 rats, 24 underwent C5—T2 ganglionectomies only, five received C4—T3 micromechanical DREZ lesions only, and eight underwent ganglionectomies plus simultaneous DREZ lesions. The animals were observed for 45 days postoperatively. Histological analysis of the spinal cord lesions was performed. All rats with ganglionectomies alone exhibited the deafferentation syndrome; however, no rats with DREZ lesions alone showed this feature. Only 25% of rats with combined ganglionectomies and DREZ lesions exhibited the deafferentation syndrome in the first 30 days, whereas 80% of the animals with ganglionectomies only did so. Although 75% of the animals with combined lesions eventually bit the insensitive forepaw, this behavior was significantly attenuated: the day of onset was delayed and the extent of self-mutilation was reduced. Postmortem histological examination of the DREZ lesions indicated a close association between the completeness of the dorsal horn destruction and the reduction or prevention of self-mutilation. These data support the validity of the animal model and also the hypothesis stating that the deafferentation syndrome results from abnormal spontaneous neural activity in the dorsal horn. Moreover, the variability of the histological findings in these experiments stresses the importance of making contiguous and complete dorsal horn lesions in human DREZ surgery.

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Guenot, Marc, Jean Bullier, and Marc Sindou. "Clinical and electrophysiological expression of deafferentation pain alleviated by dorsal root entry zone lesions in rats." Journal of Neurosurgery 97, no. 6 (December 2002): 1402–9. http://dx.doi.org/10.3171/jns.2002.97.6.1402.

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Object. The aims of this study were to construct an animal model of deafferentation of the spinal cord by brachial plexus avulsion and to analyze the effects of subsequent dorsal root entry zone (DREZ) lesions in this model. To this end, the authors measured the clinical and electrophysiological effects of total deafferentation of the cervical dorsal horn in rats and evaluated the clinical efficacy of cervical DREZ lesioning. Methods. Forty-three Sprague—Dawley rats were subjected to total deafferentation of the right cervical dorsal horn by performing a posterior rhizotomy from C-5 to T-1. The clinical effects of this deafferentation, namely self-directed mutilations consisting of scraping and/or ulceration of the forelimb skin or even autotomy of some forelimb digits, were then evaluated. As soon as some of these clinical signs of pain appeared, the authors performed a microsurgical DREZ rhizotomy ([MDR], microincision along the deafferented DREZ and dorsal horn). Before and after MDR, single-unit recordings were obtained in the deafferented dorsal horn and in the contralateral (healthy) side. The mean frequency of spontaneous discharge from the deafferented dorsal horn neurons was significantly higher than that from the healthy side (36.4 Hz compared with 17.9 Hz, p = 0.03). After deafferentation, 81.4% of the rats developed clinical signs corresponding to pain following posterior rhizotomy. Among these animals, scraping was observed in 85.7% of cases, ulceration (associated with edema) in 37.1%, and autotomy in 8.5%. These signs appeared a mean 5.7 weeks (range 1–12 weeks) after deafferentation. Thirteen rats benefited from an MDR; nine (69%) experienced a complete cure, that is, a total resolution of scraping or ulceration (a mean 4.6 weeks after MDR). In contrast, only one of 11 sham-operated animals showed signs of spontaneous recovery (p = 0.01). Conclusions. These results emphasize the role of the spinal dorsal horn in the genesis of deafferentation pain and suggest that dorsal horn deafferentation by cervical posterior rhizotomy in the rat provides a reliable model of chronic pain due to brachial plexus avulsion and its suppression by MDR.

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