Pain relief from dorsal root entry zone lesions made with argon and carbon dioxide microsurgical lasers

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✓ Argon and carbon dioxide microsurgical lasers were used to produce lesions in the dorsal root entry zone (DREZ) experimentally in six cats and surgically in 21 patients who had denervation pain syndromes. The technique of producing lesions, the histological and physiological changes seen in the cat spinal cord, and the results of treatment in the clinical series are discussed. Lesions were produced within the DREZ without new involvement of the dorsal column system or corticospinal tract in all but one patient. Based on their subjective evaluation, two-thirds of the patients were relieved of more than 50% of their preoperative pain. These experimental results and clinical experience suggest that the argon and carbon dioxide lasers effectively produce localized microsurgical lesions in the DREZ. The concept that an abnormality involving either neurons in the substantia gelatinosa or internuncial fibers in Lissauer's tract is responsible for pain in patients with primary sensory nerve deafferentation is discussed.

Article Information

Present address for Dr. Powers: Division of Neurological Surgery, University of North Carolina, Chapel Hill, North Carolina.

Address reprint requests to: Michael S. B. Edwards, M.D., % The Editorial Office, Department of Neurological Surgery, 350 Parnassus Avenue, Suite 807, San Francisco, California 94117.

© AANS, except where prohibited by US copyright law.

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    Low-power photomicrographs. H & E. Left: An acute dorsal root entry zone (DREZ) lesion in a cat spinal cord. × 6. Right: A border of a DREZ lesion in the cat spinal cord. Black arrows point to the edge of the cavity produced by laser vaporization. The white arrow points to the medial margin of the pale zone of edema; normal white matter of the dorsal column is present to the right of this zone. Between the lesion cavity and the zone of edema is a compact region of eosinophilia that is the result of coagulation necrosis. × 14.

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    Low-power photomicrograph showing a dorsal root entry zone lesion in a cat spinal cord 6 weeks after being made. Note the infiltration of macrophages and glial cells into the dorsal horn. There is no damage in the lateral corticospinal and dorsal column. Luxol-fast blue, × 7.

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    Preservation of cortical somatosensory evoked responses to posterior tibial nerve stimulation after dorsal root entry zone (Drez) lesioning of the cat thoracic cord.

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    Loss of cortical somatosensory evoked responses to right T-9 intercostal nerve stimulation at the level of dorsal root entry zone (Drez) lesioning in the thoracic region of the cat spinal cord.

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    Low-power photomicrograph showing the extension of the dorsal root entry zone lesion into the lateral aspect of the ipsilateral dorsal column (arrows). The cat had ipsilateral lower limb ataxia, but no motor weakness after lesioning. Luxol-fast blue, × 5.

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    Dorsal root entry zone lesions (arrows) made on the right side of a patient at the C-8 level for brachial plexus avulsion injury. Pia-arachnoid sutures are used to elevate and rotate the right side of the spinal cord for aligning the laser beam with the dorsal horn. Lesions are made in the area of the absent dorsal rootlets and superiorly and medially to the T-1 dorsal rootlets.

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