Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Long Term Results of Microsurgical Dorsal Root Entry Zonotomy for Upper Extremity Spasticity

  • Hong, Joo-Chul (Department of Neurosurgery College of Medicine Yeungnam University) ;
  • Kim, Min-Soo (Department of Neurosurgery College of Medicine Yeungnam University) ;
  • Chang, Chul-Hoon (Department of Neurosurgery College of Medicine Yeungnam University) ;
  • Kim, Sang-Woo (Department of Neurosurgery College of Medicine Yeungnam University) ;
  • Kim, Oh-Lyong (Department of Neurosurgery College of Medicine Yeungnam University) ;
  • Kim, Seong-Ho (Department of Neurosurgery College of Medicine Yeungnam University)
  • Published : 2008.04.28
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Abstract

Objective : The purpose of the present study is to assess the long-term results of microsurgical dorsal root entry zonotomy (MDT) for the treatment of medically intractable upper-extremity spasticity. Methods : The records of nine adult patients who underwent MDT by one operating neurosurgeon from March 1999 to June 2004 were retrospectively reviewed by another investigator who had no role in the management of these patients. In all patients, MDT was performed on all roots of the upper limb (from C5 to T1) for spasticity of the upper extremity. The degree of spasticity was measured by the Modified Ashworth Scale (grade 0-4). Severity of the pain level was determined using the Numeric Rating Scale (NRS, score 0-10). Also, patient satisfaction of the post-operative outcome was assessed. Results : Comparing the preoperative and postoperative spasticity using the Modified Ashworth Scale, we observed improvement in all patients, particularly in five of the nine patients (55.6%) who improved by three grades over an average of 66.4 months (range, 40-96). Regarding patient satisfaction, seven patients (77.8%) had affirmative results. None of the patients experienced severe, life-threatening, postoperative complications. We observed a decrease in the intensity of painful spasms to less than three scores as measured by NRS in all four patients with associated pain. Conclusion : This study shows that MDT provides significant, long-term reduction of harmful spasticity and associated pain in the upper limbs.

Keywords

References

  1. Cook AW, Weinstein SP : Chronic dorsal column stimulation in multiple sclerosis. Preliminary report. N Y State J Med 73 : 2868-2872, 1973
  2. Cooper IS : Effect of chronic stimulation of anterior cerebellum on neurological disease. Lancet 1 : 206, 1973 https://doi.org/10.1016/S0140-6736(02)95526-1
  3. Dreval ON : Ultrasonic DREZ-operations for treatment of pain due to brachial plexus avulsion. Acta Neurochir (Wien) 122 : 76-81, 1993 https://doi.org/10.1007/BF01446990
  4. Gros C, Ouaknine G, Vlahovitch B, Frèrebeau P : [Selective posterior radicotomy in the neurosurgical treatment of pyramidal hypertension]. Neurochirurgie 13 : 505-518, 1967
  5. Kim SR, Lee KJ, Cho JG, Rha HK, Park HK, Kang JK, et al : Microsurgical DREZotomy for deafferentation pain. J Korean Neurosurg Soc 30 : 85-90, 2001
  6. Lance JW : The control of muscle tone, reflexes, and movement : Robert Wartenberg Lecture. Neurology 30 : 1303-1313, 1980 https://doi.org/10.1212/WNL.30.12.1303
  7. Lazorthes Y, Sol JC, Sallerin B, Verdiè JC : The surgical management of spasticity. Eur J Neurol 9 (Suppl 1) : 35-41; discussion 53-61, 2002
  8. Levy WJ, Nutkiewicz A, Ditmore QM, Watts C : Laser-induced dorsal root entry zone lesions for pain control. Report of three cases. J Neurosurg 59 : 884-886, 1983 https://doi.org/10.3171/jns.1983.59.5.0884
  9. Nashold BS Jr : Current status of the DREZ operation : 1984. Neurosurgery 15 : 942-944, 1984 https://doi.org/10.1227/00006123-198412000-00034
  10. Nashold BS Jr, Ostdahl RH : Dorsal root entry zone lesions for pain relief. J Neurosurg 51 : 59-69, 1979 https://doi.org/10.3171/jns.1979.51.1.0059
  11. Park YB, Kim SH, Kim SW, Chang CH, Ahn SH, Jang SH : Long term results of microsurgical dorsal root entry zonotomy for intractable pain associated with brachial plexus injury. J Korean Neurosurg Soc 40 : 143-147, 2006
  12. Penn RD, Kroin JS : Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1 : 1078, 1984
  13. Samii M, Bear-Henney S, Lüdemann W, Tatagiba M, Blömer U : Treatment of refractory pain after brachial plexus avulsion with dorsal root entry zone lesions. Neurosurgery 48 : 1269-1275; discussion 1275-1267, 2001 https://doi.org/10.1097/00006123-200106000-00016
  14. Sampson JH, Cashman RE, Nashold BS Jr, Friedman AH : Dorsal root entry zone lesions for intractable pain after trauma to the conus medullaris and cauda equina. J Neurosurg 82 : 28-34, 1995 https://doi.org/10.3171/jns.1995.82.1.0028
  15. Sindou M : Drez lesions for brachial plexus injury. Neurosurgery 23 : 528, 1988
  16. Sindou M, Fischer G, Goutelle A, Schott B, Mansuy L : [Selective posterior rhizotomy in the treatment of spasticity]. Rev Neurol (Paris) 130 : 201-216, 1974
  17. Sindou M, Mertens P : Neurosurgery for spasticity. Stereotact Funct Neurosurg 74 : 217-221, 2000 https://doi.org/10.1159/000056483
  18. Sindou M, Mifsud JJ, Boisson D, Goutelle A : Selective posterior rhizotomy in the dorsal root entry zone for treatment of hyperspasticity and pain in the hemiplegic upper limb. Neurosurgery 18 : 587-595, 1986 https://doi.org/10.1227/00006123-198605000-00013
  19. Smyth MD, Peacock WJ : The surgical treatment of spasticity. Muscle Nerve 23 : 153-163, 2000 https://doi.org/10.1002/(SICI)1097-4598(200002)23:2<153::AID-MUS3>3.0.CO;2-4
  20. Waltz JM, Reynolds LO, Riklan M : Multi-lead spinal cord stimulation for control of motor disorders. Appl Neurophysiol 44 : 244-257, 1981
  21. Whitworth LA, Feler CA : Application of spinal ablative techniques for the treatment of benign chronic painful conditions : history, methods, and outcomes. Spine 27 : 2607-2612; discussion 2613, 2002 https://doi.org/10.1097/00007632-200211150-00039

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