Dorsal root entry zone microcoagulation for spinal cord injury-related central pain: operative intramedullary electrophysiological guidance and clinical outcome
Dorsal root entry zone microcoagulation for spinal cord injury-related central pain: operative intramedullary electrophysiological guidance and clinical outcome
复制标题
DOI：
10.3171/spi.2002.97.2.0193
复制
发表时间：
2002-09-01
影响因子：
4.1
通讯作者：
Starnes, C
中科院分区：
文献类型：
--
作者：
Falci, S;Best, L;Starnes, C
目的。通过手术对脊髓背根进入区 (DREZ) 进行损伤以缓解脊髓损伤 (SCI) 后的中枢性疼痛，历来效果不佳。对文献的回顾表明，当进行经验性手术时，大约 50% 的患者可以得到中等至良好的疼痛缓解。本研究旨在确定 DREZ 损伤中的髓内电引导是否可以改善 SCI 引起的中枢性疼痛患者的预后。此外，还使用电数据来确定是否可以针对这种中枢性疼痛对脊髓进行体位图绘制。方法。 41 名患有创伤性 SCI 和顽固性中枢性疼痛的患者接受了 DREZ 损伤治疗，其中进行了髓内电引导。在 9 名患者中，记录 DREZ 相关的自发性电亢进指导了病变过程。在 32 名患者中，在经皮 C 纤维刺激 (TCS) 过程中记录 DREZ 诱发的电过度活动还可以引导病变。随访期为1年至7年。分析的电数据允许对脊髓进行体位图绘制。结论。与经验技术相比，DREZ 损伤的髓内电引导可显着改善创伤性 SCI 引起的中枢性疼痛患者的疼痛结果。当 DREZ 相关的自发性电过度活动和 TCS 期间诱发的过度活动都用于指导 DREZ 损伤过程时，会出现最佳结果。在这样的指导下，84% 的患者疼痛得到 100% 缓解，88% 的患者疼痛缓解 50% 到 100%。电数据的体位映射提出了一种针对低水平疼痛的疼痛机制，涉及交感神经系统。
Object. Surgically created lesions of the spinal cord dorsal root entry zone (DREZ) to relieve central pain after spinal cord injury (SCI) have historically resulted in modest outcomes. A review of the literature indicates that fair to good relief of pain is achieved in approximately 50% of patients when an empirical procedure is performed. This study was undertaken to determine if intramedullary electrical guidance in DREZ lesioning could improve outcomes in patients with SCI-induced central pain. Additionally, electrical data were used to determine if the spinal cord could be somatotopically mapped with regard to this pain of central origin.Methods. Forty-one patients with traumatic SCI and intractable central pain underwent DREZ lesioning in which intramedullary electrical guidance was conducted. In nine patients, recording of DREZ-related spontaneous electrical hyperactivity guided the lesioning process. In 32 patients, recording of DREZ-induced evoked electrical hyperactivity during transcutaneous C-fiber stimulation (TCS) additionally guided lesioning. The follow-up period ranged from 1 to 7 years. The analyzed electrical data allowed for somatotopic mapping of the spinal cord.Conclusions. Intramedullary electrical guidance of DREZ lesioning substantially improves pain outcomes in patients with traumatic SCI-induced central pain, compared with an empiric technique. The best outcome occurs when DREZ-related spontaneous electrical hyperactivity and evoked hyperactivity during TCS are both used to guide the DREZ lesioning procedure. With such guidance, 100% relief of pain was achieved in 84% of patients and 50 to 100% relief of pain in 88%. Somatotopic mapping of the electrical data led to a proposed pain mechanism for below-level pain, implicating the sympathetic nervous system.