A modified microsurgical DREZotomy procedure for refractory neuropathic pain.

Abstract

Control of neuropathic pain secondary to spinal cord injury is difficult; microsurgical DREZotomy (MDT) is the currently preferred treatment modality. According to previous reports, traditional MDT has poor outcomes when addressing diffuse (infralesional), thermal, and continuous pain. Here, we report improvements in surgical outcomes in these neuropathic pain conditions using a modified MDT technique. Patients with segmental, mechanical, or intermittent pain underwent MDT using the traditional (Sindou's) technique performed at the indicated cord level based on pain distribution. Patients suffering from diffuse, thermal, or continuous pain underwent a modified MDT procedure in the "lump" and "irritative" zones, as well as another procedure, whereby an attempt was made to cut every injured and fused rootlet. In 38 patients with paraplegic pain resulting from a spinal cord injury occurring within the preceding 7 years, 11 of 15 patients (73%) with a diffuse pain distribution had a good reduction in pain. Thirteen patients (86%) with continuous pain noted good pain relief. In patients with thermal pain, only one patient (20%) demonstrated a good response to the investigational procedure. These procedures, including the modified MDT technique, may be helpful in controlling paraplegic pain in patients suffering from diffuse, thermal, or continuous pain.