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Blaine S. Nashold Jr. and Roger H. Ostdahl

with intractable pain from brachial plexus avulsion injuries were treated with a new surgical technique of radiofrequency coagulation of the dorsal root entry zone (DREZ) of the cervical cord in the region of the avulsed nerve roots. The lesions created were originally intended to destroy the substantia gelatinosa at selected levels. 24 However, in view of the complicated anatomy of the DREZ 12, 28, 30, 32, 36, 39 and the lack of histological confirmation of the lesion in our patients, we have elected to refer to the thermocoagulation target as “the DREZ.” The

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Keisuke Takai and Makoto Taniguchi

Transcript We herein demonstrate our modified dorsal root entry zone lesioning procedure for pain relief in a case of cervical root avulsion injury. 0:32 The Anatomy and Pathways of the Posterior Horn. Illustrations ( Supplemental Fig. 1 ) show the anatomy (left) and pathways (right) of the posterior horn of a healthy spinal cord. The posterior horn of spinal gray matter comprises six regions, the laminae of Rexed I–VI (left). Neurons in the deep layers are called wide-dynamic-range neurons (right), which play a role in pain conduction. 1 1:06 Original DREZ

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Mahmood Fazl and David A. Houlden

cord evoked potential reappeared but was longer in latency ( Fig. 2 ). In two animals a dorsal column section showed abolition of the evoked potential following dorsal stimulation, but the evoked potential following dorsolateral stimulation was not affected. Fig. 2. Evoked potential recordings showing results of stimulation of the dorsolateral (LATERAL) and dorsal spinal cord and the dorsal root entry zone (DREZ). The evoked potential is absent following DREZ stimulation. In contrast, stimulation of the dorsolateral and dorsal spinal cord produced evoked

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Mahmood Fazl, David A. Houlden, and Zelma Kiss

T he dorsal root entry zone (DREZ) radiocoagulation technique was initially introduced by Nashold, et al. , 8 for deafferentation pain associated with brachial plexus avulsion. The same procedure has also been performed for relief of postherpetic neuralgia and paraplegic or quadriplegic pain, although with a lesser degree of success. 2 Proximity of the lateral corticospinal tract and dorsal column to the site of DREZ lesioning is an inherent problem of this procedure that leads to unwanted neurological deficits. For example, motor weakness of the

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Eugene Rossitch Jr., M. Abdulhak, Janice Ovelmen-Levitt, M. Levitt, and Blaine S. Nashold Jr.

C hronic deafferentation pain can result from loss of primary afferent input to the central nervous system. 23 Patients with these disorders present one of the most challenging pain management problems confronting health-care professionals. Until relatively recently, there has been little to offer these patients. Medical treatment is largely limited to antidepressant, sedative, or anticonvulsant medication, or psychological counseling. 25 Prior to the dorsal root entry zone (DREZ) operation, surgical therapy often employed other neurodestructive, but

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Stephen E. Sandwell and Amr O. El-Naggar

of enhanced sensory and motor function during stimulation . Neurosurgery 56 : 290 – 297 , 2005 3 Bullard DE , Nashold BS Jr : The caudalis DREZ for facial pain . Stereotact Funct Neurosurg 68 : 168 – 174 , 1997 4 Cruccu G , Aziz TZ , Garcia-Larrea L , Hansson P , Jensen TS , Lefaucheur JP , : EFNS guidelines on neurostimulation therapy for neuropathic pain . Eur J Neurol 14 : 952 – 970 , 2007 5 El-Naggar AO , Nucleus caudalis dorsal root entry zone lesioning for intractable facial pain . Starr PA , Barbaro NM

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Marc Guenot, Jean Bullier, and Marc Sindou

, Hammond DL , Jensen TS (eds): Proceedings of the 7th World Congress on Pain. Progress in Pain Research and Management. Seattle : IASP Press , 1994 , Vol 2 , pp 437 – 454 Fields HL, Rowbotham MC: Multiple mechanisms of neuropathic pain: a clinical perspective, in Gebhart GF, Hammond DL, Jensen TS (eds): Proceedings of the 7th World Congress on Pain. Progress in Pain Research and Management. Seattle: IASP Press, 1994, Vol 2, pp 437–454 16. Friedman AH , Nashold BS Jr , Bronec PR : Dorsal root entry zone

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Nestor D. Tomycz and John J. Moossy

–6 anterior cervical discectomy and fusion, and he agreed to proceed once he received approval from the cardiology department to temporarily suspend the use of clopidogrel for recently placed coronary stents. F ig . 1. Cervical lateral radiograph showing postlaminectomy kyphosis. F ig . 2. Sagittal (A) and axial (B) T2-weighted MR imaging sequences demonstrate dorsolateral lesions in the dorsal root entry zone. Axial T2-weighted MR image (C) showing a pseudomeningocele at the site of left T-1 nerve root avulsion. F ig . 3. Axial T2-weighted MR

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Andrew L. Ko, Alp Ozpinar, Jeffrey S. Raskin, Stephen T. Magill, Ahmed M. Raslan, and Kim J. Burchiel

), with a statistically significant but slight reduction in pain scores. 21 , 22 Ablative procedures such as medial thalamotomy, spinothalamic tractotomy, and anterolateral cordotomy have not demonstrated long-term benefits and have disabling side effects. 30 On the other hand, dorsal root entry zone (DREZ) lesioning—or DREZotomy—has been shown to be a durable and effective treatment for neuropathic pain resulting from BPA. 1 , 2 , 5 , 9 , 24 , 25 , 27 , 29 Though not as frequently performed as a few decades ago, DREZotomy remains a potent surgical therapy for the

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John H. Sampson, Robert E. Cashman, Blaine S. Nashold Jr., and Allan H. Friedman

deficits are incomplete. Although ablative lesions in the dorsal root entry zone (DREZ) have been shown to relieve pain in the majority of patients with pain of spinal cord origin, 6, 7, 13, 15, 18 such lesions have been shown not to relieve pain of peripheral nerve origin. 24, 25 Therefore, this review was undertaken to determine the benefits and risks of DREZ lesioning in 39 patients with intractable pain caused by trauma to the conus medullaris and cauda equina. Clinical Material and Methods Patient Population Thirty-nine patients were included in this