Invasive Treatment for Spinal Pain

Kim, Young Soo

Review article

Journal of the Korean Society of Stereotactic and Functional Neurosurgery 2006;2(2):126-130.
Published online September 30, 2006.

Invasive Treatment for Spinal Pain

Young Soo Kim

Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea

Abstract

Objective
s: It is difficult to control a chronic intractable spinal pain in spite of several non-invasive treatment including a spinal interventional treatment and a spinal stimulation. If above treatment modalities are failed, invasive surgical treatment might be considered. Dorsal root entry zone (DREZ) lesioning is the mainstay of the invasive treatment for spinal pain. Author reviewed the clinical experience about DREZ lesioning for control of chronic spinal pain.
Methods
: Fifty one patients who had severe intractable spinal pain and neuropathic pain were reviewed from July 1995 to August 2006. Their diagnoses were paraplegic pain, cancer pain, stump pain, root avulsion pain and phantom limb pain. Two surgical techniques were used. One was a radiofrequency (RF) coagulation on DREZ. The other was a microDREZotomy (MDT). Comparison of surgical result was evaluated with visual analogue scale and three categorical scale (good, fair, poor).
Results
: Overall surgical results showed that improvement of VAS was from 8.2±0.8 to 3.2±2.1 and on the basis of categorical scale, ‘good’ was 35 cases (68.6%), ‘fair’ 10 cases (19.7%), and ‘poor’ 6 cases (11.7%). But surgical result for paraplegic pain (40 cases)was better than other disease. Its result was that ‘good’ was 30 cases (75%), ‘fair’ 7 cases (17.5%), and ‘poor’ 3 cases (7.5%). There was not statistically significant to comparison between RF coagulation and MDT.
Conclusion
: Author proposes that invasive surgical treatment such as DREZ lesioning is the good indication for the control of chronic intractable spinal pain and the neuropathic pain.

Key Words: Spinal pain, Paraplegic pain, DREZ lesioning.