Seminars in Neurosurgery 2004; 15(2/03): 221-232
DOI: 10.1055/s-2004-835710
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Surgery in the Dorsal Root Entry Zone for Pain

Marc P. Sindou1 , Patrick Mertens1
  • 1Department of Neurosurgery, University of Lyon, Lyon, France
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Publication History

Publication Date:
25 October 2004 (online)

The dorsal root entry zone (and dorsal horn)-which is the first important level of modulation for pain sensation-can be a neurosurgical target to treat resistant pain. Lesioning techniques include microsurgical coagulation, radiofrequency thermocoagulation, laser beam or ultrasound lesion maker. Indications are (1) malignant pain in patients with long life expectancy and cancer that is limited in extent (such as in Pancoast-Tobias syndrome); (2) persistent neuropathic pain that is due to (a) brachial plexus injuries, especially those with avulsion, (b) spinal cord lesions (predominantly in the conus medullaris), especially the pain corresponding to segmental lesions (pain below the lesion is not favorably influenced), (c) segmental pain caused by lesions in the cauda equina, (d) peripheral nerve injuries, amputation, or herpes zoster, when the predominant component of pain is of the paroxysmal type and/or corresponds to provoked allodynia or hyperalgesia; and (3) disabling hyperspastic states with pain.