The Efficacy of Doral Root Entry Zone(DREZ) Lesions Making for Intractable Pain and DREZ-otomy for Inractable Spasticity

Kim, Young Seok; Kim, Bum Tae; Shin, Won Han; Choi, Soon Kwan; Byun, Bark Jang

Abstract

The dorsal root entry zone(DREZ) lesions making by focal destruction of the substantia gelatinosa controls intractable pain, and the DREZ-otomy by the selective destroying mainly the laterally located nociceptive and centrally located myotactic afferent fibers within the posterior root relieves the spasticity of the limbs. The authors analysed the results of 12 patients, treated by the DREZ lesions making for intractable pain, and 6 patients, treated by the DREZ-otomy for intractable spasticity of lower extremities, who were admitted to department of neurosurgery of Soonchunhyung University from 1983 to 1993. The obtained results were as follows. 1) Among the 12 patients suffered from intractable pain, three were brachial plexus avulsion, three were spinal cord injury, two were causalgia, and the others were paraneoplastic syndrome, metastatic carcinoma, postoperative spinal cord tumor, and atypical facial pain respectively. There were six patients intractable spasticity of that major cause was diffuse axonal injury(67%), and of that major posture was decorticate rigidity(83%). 2) The rate of immediate relief of intractable pain and spasticity was 82% in each after DREZ lesions making or DREZ-otomy. 3) The result of pain relief by the DREZ lesions making was excellent(100%) in brachial plexus avulsion, and poor(almost no relief) in paraplegic pain of spinal cord injury. 4) After DREZ-otomy on bilateral conus medullaris sparing S(2-4) segment, the degree of spasticity of lower extremitries reduced gradually to mean Ashworth scale 2.1 from mean 5. 5) Five of six patients of the bedridden state due to harmful spasticity was able to do comfortably wheel chair ambulation immediately after operation.