Success with dorsal root entry zone lesioning after a failed trial of spinal cord stimulation in a patient with pain due to brachial plexus avulsion.
Success with dorsal root entry zone lesioning after a failed trial of spinal cord stimulation in a patient with pain due to brachial plexus avulsion.
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DOI：
10.1097/pr9.0000000000000973
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发表时间：
2021-11
期刊：
影响因子：
4.8
通讯作者：
Sdrulla AD
中科院分区：
文献类型：
--
作者：
Lopez L;Sdrulla AD
我们报告一位因臂丛神经撕脱引起严重疼痛的病人，在颈髓刺激失败后，成功地进行了背根进入区损伤。由臂丛神经病变（BP）引起的疼痛是一个具有挑战性的临床问题，几乎没有有效的治疗方法。在这里，我们提出了一个严重的，痛苦的BP后，高冲击机动车事故谁保守治疗失败的病人。在14天内使用多种波形（强直、BurstDR和10 kHz）完成了一项颈脊髓刺激试验，仅疼痛减轻了30%至40%。随后，他接受了背根进入区损伤，1年后疼痛明显减轻。手术探查发现他的颈神经根有广泛的损伤和撕脱，这在以前的臂丛磁共振成像中没有观察到。我们讨论了创伤性BP的病因和诊断，脊髓刺激试验失败的可能原因，以及治疗的意义。
We report a case of successful dorsal root entry zone lesioning after a failed trial of cervical spinal cord stimulation in a patient with severe pain due to brachial plexus avulsion. Pain caused by brachial plexopathy (BP) represents a challenging clinical problem with few effective therapeutic options. Here, we present a patient with severe, painful BP after a high-impact motor vehicle accident who failed conservative treatments. A trial of cervical spinal cord stimulation was completed using multiple waveforms (tonic, BurstDR, and 10 kHz) over 14 days with only 30% to 40% pain reduction. Subsequently, he underwent dorsal root entry zone lesioning with a significant decrease in his pain 1 year later. Surgical exploration revealed extensive damage and avulsion of his cervical roots that was not observed on a previous brachial plexus magnetic resonance imaging. We discuss the etiology and diagnosis of traumatic BP, possible reasons for the failed spinal cord stimulation trial, and implications for management.