Drez Surgery on Conus Medullaris (After Failed Implantation of Vascular Omental Graft) for Treating Chronic Pain due to Spine (Gunshot) Injuries

Abstract

The results of DREZlesioning procedure used for the treatment of chronic intractable pain due to deafferentation caused by gunshot injuries at the thoracolumbar (T10-L1) spine level are reported in six patients. The specificity of these cases arises from the fact that all the patients underwent, after decompressive laminectomy, an implantation of vascularized omental graft on the injured cord segments, 4-17 months after injury. Because of the failure of this method, which did not improve spinal function nor hinder the development of pain, surgery in the DREZ was performed 2-5 years after implantation. The results of the microsurgical DREZotomy procedure in those patients, 7-12 months after the surgery were: 4 patients with complete pain relief and 2 patients with pain relieved of 80%. All the patients with well-confined segmental pain were completely cured.

Neuropathic Pain Post Spinal Cord Injury Part 2: Systematic Review of Dorsal Root Entry Zone Procedure

“…One study conducted a prospective controlled trial, 14 1 utilized a pre-post study design, 9 and 9 studies utilized a case series study design [6][7][8][15][16][17][18][19][20] (see Table 2). In each study, an intervention for pain was administered to an individual with SCI, and the change in pain was measured; only 1 study compared treated individuals with those in a control group.…”

“…6,9,19,20 Sindou's technique for MDT involves selectively destroying nociceptive fibers and hyperactive neurons, which interfere with the neurogenic mechanism causing pain. 20 Chun et al 9 reported on 38 individuals treated with the procedure between 2003 and 2008. These individuals had various types of neuropathic pain including segmental versus diffuse, mechanical versus thermal, or a combination of both, and intermittent versus continuous pain.…”

“…Spaic et al 6,20 conducted a pre-post study to assess the effect of MDT on individuals with neuropathic pain. Participants self-reported their pain levels using the VAS at 7 to 12 months 20 and 13 to 50 months after surgery.…”

“…Six studies included individuals with only neuropathic pain, 6,9,14,15,17,20 and 3 studies included individuals with mixed pain 8,16,19 ; in 2 studies the origin of pain was not indicated. 7,18 The presence of neuropathic pain was determined by means of a clinical interview or pain descriptors.…”

“…One study provided level 2 evidence, 14 and 10 provided level 4 evidence. 4,[6][7][8][9][15][16][17][18][19][20] Sample sizes ranged from 6 to 56. Ages of individuals in the studies ranged from 17 to 75 years, with an average age of 39 years.…”