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Surgery in the Dorsal Root Entry Zone for Spasticity

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Textbook of Stereotactic and Functional Neurosurgery

Abstract

Surgery in the dorsal root entry zone (DREZ) was introduced in 1972 [1,2] to treat intractable pain. Because of its inhibitory effects on muscular tone, it has been applied to patients with focalized hyperspasticity [3–6]. This method – named microsurgical DREZotomy (MDT) – attempts to selectively interrupt the small nociceptive and the large myotatic fibers (situated laterally and centrally, respectively), while sparing the large lemniscal fibers which are regrouped medially. It also enhances the inhibitory mechanisms of Lissauer’s tract and dorsal horn [7] (Figure 116-1 ).

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References

  1. Sindou M. Etude de la jonction radiculo-médullaire postérieure: la radicellotomie postérieure sélective dans la chirurgie de la douleur. Lyon: These med; 1972.

    Google Scholar 

  2. Sindou M, Quoex C, Baleydier C. Fiber organization at the posterior spinal cord-rootlet junction in man. J Comp Neurol 1974;153:15–26.

    Article  PubMed  CAS  Google Scholar 

  3. Sindou M, Fisher G, Goutelle A, et al. La radicellotomie postérieure sélective dans le traitement des spasticités. Rev Neurol 1974;130:201–15.

    PubMed  CAS  Google Scholar 

  4. Sindou M, Millet MF, Mortamais J, et al. Results of selective posterior rhizotomy in the treatment of painful and spastic paraplegia secondary to multiple sclerosis. Appl Neurophysiol 1982;45:335–40.

    PubMed  CAS  Google Scholar 

  5. Sindou M, Abdennebi B, Sharkey P. Microsurgical selective procedures in the peripheral nerves and the posterior root-spinal cord junction for spasticity. Appl Neurophysiol 1985;48:97–104.

    PubMed  CAS  Google Scholar 

  6. Sindou M, Pregelj R, Boisson D, et al. Surgical selective lesions of nerve fibers and myelotomies for the modifications of muscle hypertonia. In: Sir Eccles J, Dimitrijevic, MR, editors. Recent achievements in restorative neurology: upper motor neuron functions and dysfunctions. Basel: S. Karger; 1985. p. 10–26.

    Google Scholar 

  7. Eccles J, Eccles R, Magni F. Central inhibitory action attributable to presynaptic depolorization produced by muscle afferent volleys. J Physiol 1961;159:147–66.

    PubMed  CAS  Google Scholar 

  8. Sindou M, Jeanmonod D, Mertens P. Surgery in the DREZ: microsurgical DREZotomy for treatment of spasticity. In: Sindou M, Abbott R, Keravel Y, editors. Neurosurgery for spasticity. Wien: Springer; 1991. p. 165–82.

    Google Scholar 

  9. Sindou M, Jeanmonod D. Microsurgical DREZ-tomy for the treatment of spasticity and pain in the lower limbs. Neurosurgery 1989;24:655–70.

    Article  PubMed  CAS  Google Scholar 

  10. Sindou M, Mifsud JJ, Boisson D, et al. Selective posterior rhizotomy in the dorsal root entry zone for treatment of hyperspasticity and pain in the hemiplegic upper limb. Neurosurgery 1986;18:587–95.

    Article  PubMed  CAS  Google Scholar 

  11. Beneton C, Mertens P, Leriche, et al. The spastic bladder and its treatment. In: Sindou M, Abbott R, Keravel Y. Neurosurgery for spasticity: a multidisciplinary approach. New York: Springer; 1991. p. 193–9.

    Google Scholar 

  12. Willis WD. Pain system. Basel: Karger; 1985.

    Google Scholar 

  13. Rand R. Further observations on Lissauer’s tractolysis. Neurochirurgica 1960;3:151–68.

    CAS  Google Scholar 

  14. Denny-Brown D, Kirk EJ, Yanagisawa N. The tract of Lissauer in relation to sensory transmission in the dorsal horn of spinal cord in the macaque monkey. J Comp Neurol 1973;151:175–200.

    Article  PubMed  CAS  Google Scholar 

  15. Ramon y Cajal S. Histologie du systéme nerveux, vol. 1. Paris: Maloine; 1901.

    Google Scholar 

  16. Szentagothai J. Neuronal and synaptic arrangement in the substantia gelatinosa. J Comp Neurol 1964;122:219–39.

    Article  PubMed  CAS  Google Scholar 

  17. Wall PD. Presynaptic control of impulses at the first central synapse in the cutaneous pathway. In: Eccles JC, Schadé JP, editors. Physiology of spinal neurons. Amsterdam: Elsevier; 1964. p. 92–118.

    Google Scholar 

  18. Jeanmonod D, Sindou M, Magnin M, et al. Intra-operative unit recordings in the human dorsal horn with a simplified floating microelectrode. Electroencephalogr Clin Neurophysiol 1989;72:450–4.

    Article  PubMed  CAS  Google Scholar 

  19. Guenot M, Hupe JM, Mertens P, et al. New type of microelectrode for obtaining unitary recordings in the human spinal cord. J Neurosurg (Spine) 1999;91:25–32.

    Article  CAS  Google Scholar 

  20. Guenot M, Bullier J, Rospars J, et al. Single-unit analysis of the spinal dorsal horn in patients with neuropathic pain. J Clin Neurophysiol 2003;20:142–50.

    Google Scholar 

  21. Loeser JD, Ward AA, Jr, White LE, Jr. Some effects of deafferentation of neurons. J Neurosurg 1967;17:629–36.

    CAS  Google Scholar 

  22. Albe-Fessard D, Lombard MC. Use of an animal model to evaluate the origin of and protection against deafferentation pain. In: Bonica JJ, et al. editors. Advances in pain research and therapy, vol. 5. New York: Raven Press; 1983. p. 691–700.

    Google Scholar 

  23. Guenot M, Bullier J, Sindou M. Clinical and electrophysiological expression of deafferentation pain alleviated by dorsal root entry zone lesions in rats. J Neurosurg 2002;97:1402–9.

    Article  PubMed  Google Scholar 

  24. Mertens P, Ghaemmaghami C, Bert L, et al. Microdialysis study of amino-acid neurotransmitters in the spinal dorsal horn of patients undergoing microsurgical dorsal root entry zone lesioning. J Neurosurg (Spine 1) 2001;94:165–73.

    Article  CAS  Google Scholar 

  25. Jeanmonod D, Sindou M. Somatosensory function following dorsal root entry zone lesions in patients with neurogenic pain or spasticity. J Neurosurg 1991;74:916–32.

    Article  PubMed  CAS  Google Scholar 

  26. Sindou M, Fischer G, Mansuy L. Posterior spinal rhizotomy and selective posterior rhizidiotomy. In: Krayenbühl H, Maspes PE, Sweet WH, editors. Progress in neurological surgery, vol. 7. Basel: Karger; 1976. p. 201–50.

    Google Scholar 

  27. Sindou M, Goutelle A. Surgical posterior rhizotomies for the treatment of pain. In: Krayenbühl H, editor. Advances and technical standards in neurosurgery, vol. 10. Vienna: Springer; 1983. p. 147–85.

    Google Scholar 

  28. Mertens P, Guénot M, Hermier M, et al. Radiologic anatomy of the spinal dorsal horn at the cervical level (anatomy – MRI correlations). Surg Radiol Anat 2000;22:81–8.

    Article  PubMed  CAS  Google Scholar 

  29. Sindou M. Microsurgical DREZotomy (MDT) for pain, spasticity and hyperactive bladder: a 20 year experience. Acta Neurochir 1995;137:1–5.

    Article  CAS  Google Scholar 

  30. Sindou M, Abbott R, Keravel Y (eds.). “Neurosurgery for spasticity.” Wien: Springer; 1991.

    Google Scholar 

  31. Decq P, Mertens P. La Neurochirurgie de la Spasticité, Neurochirurgie. Masson: Paris; 2003.

    Google Scholar 

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Authors
  1. M. P Sindou
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  2. P. Mertens
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Editor information

Editors and Affiliations

  1. Canadian Research Chair in Neuroscience (Tier 1), 399 Bathurst St. WW 4-447, Toronto, Ontario, M5T 2S8, Canada

    Andres M. Lozano (Professor of Surgery and RR Tasker Chair in Functional Neurosurgery University of Toronto Senior Scientist, Toronto Western Research Institute President, World Society for Stereotactic and Functional Neurosurgery) (Professor of Surgery and RR Tasker Chair in Functional Neurosurgery University of Toronto Senior Scientist, Toronto Western Research Institute President, World Society for Stereotactic and Functional Neurosurgery)

  2. Houston Stereotactic Concepts, Inc., 2260 West Holcombe Boulevard Suite 309, Houston, Texas, 77030, USA

    Philip L. Gildenberg

  3. University of Toronto, 399 Bathurst St. WW 4-447, Toronto, Ontario, M5T 2S8, Canada

    Ronald R. Tasker

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© 2009 Springer-Verlag Berlin Heidelberg

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Sindou, M.P., Mertens, P. (2009). Surgery in the Dorsal Root Entry Zone for Spasticity. In: Lozano, A.M., Gildenberg, P.L., Tasker, R.R. (eds) Textbook of Stereotactic and Functional Neurosurgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69960-6_116

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  • DOI: https://doi.org/10.1007/978-3-540-69960-6_116

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-69959-0

  • Online ISBN: 978-3-540-69960-6

  • eBook Packages: MedicineReference Module Medicine

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