• Journal of Yeungnam Medical Science
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• 제19권1호
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• pp.49-54
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• 2002

척수손상 환자에게 동반되는 통증은 흔하지만 치료에 잘 반응하지 않고 환자들의 일상생활에 더욱 장애를 줄 수 있는 합병증의 하나로 알려져 있다. 3년 전 외상성 척수손상으로 인하여 불완전 하지 마비 소견을 보였던 52세 된 남자 환자로 손상 직후부터 발생된 양측 T10위치의 분절통과 손상 1개월 후부터 발생된 양하지 통증이 있어 약물요법, 물리치료, 및 운동치료 등의 여러 가지 치료를 시행하였으나 치료에 잘 반응하지 않아 DREZ(Dorsal Root Entry Zone)otomy 수술을 시행한 후 분전통이 호전된 증례가 있어 이를 보고하고자 하였다. 보존적 치료에 잘 반응하지 않는 척수손상 후 통증의 경우 DREZotomy 수술도 도움이 될 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제30권sup1호
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• pp.85-90
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• 2001

Objective : DREZotomy is effective for the treatment of deafferentation pain as a consequence of root avulsion, postparaplegic pain, posttraumatic syrinx, postherpetic neuralgia, spinal cord injury, and peripheral nerve injury. We performed microsurgical DREZotomy to the patients with deafferentation pain and relieved pain without any serious complication. The purpose of this study is to evaluate the usefulness of the microsurgical DREZotomy for deafferentation pain. Methods : We evaluated 4 patients with deafferntation pain who were intractable to medical therapy. Two of them were brachial plexus injury with root avulsion owing to trauma, one was axillary metastasis of the squamous cell carcinoma of the left forearm, and the last was anesthesia dolorosa after surgical treatment(MVD and rhizotomy) of trigeminal neuralgia. Preoperative evaluation was based on the neurologic examination, radiologic imaging, and electrophysiological study. In the case of anesthesia dolorosa, we produced two parallel lesions in cephalocaudal direction, 2mm in distance, from the C2 dorsal rootlet to the 5mm superior to the obex including nucleus caudalis, after suboccipital craniectomy and C1-2 laminectomy, with use of microelectrode. In the others, we confirmed lesion site with identification of the nerve root after hemilaminectomy. We performed arachnoid dissection along the posterolateral sulcus and made lesion with microsurgical knife and microelectrocoagulation, 2mm in depth, 2mm in distance, to the direction of 30-45 degrees in the medial portion of the Lissauer's tract and the most dorsal layers of the posterior horn at the one root level above and below the lesion. Results : Compared with preoperative state, microsurgical DREZotomy significantly diminished dosage of the drugs and relieved pain meaningfully. One patient showed tansient ipsilateral ataxia, but recovered soon. There was not any serious complication. Conclusion : It may be concluded that microsurgical DREZotomy is very useful and safe therapeutic modality for deafferentation pain, especially segmentally distributed intermittent or evoke pain. Complete preoperative evaluation and proper selection of the patients and lesion making device are needed to improve the result.