selective dorsal rhizotomy

[tsechi]

Who can tell me what is "selective dorsal rhizotomy"?
what kinds of injury need this operation?

Thanks.

[tshombe]

Tsechi,


Who can tell me what is "selective dorsal rhizotomy"?
what kinds of injury need this operation?
Thanks.

Its an old operation technique IMO. They cut some peripheral nerves to get
rid of neuropatic pain usely by incomplete low injuries. Because of poorly
results neurosurgeons in my country (Belgium) left this procedure years ago.
Hope this may help.
Wilfried.

[Wise Young]

Rhizotomy refers to cutting of spinal roots. Dorsal root rhizotomy refers to the cutting of dorsal roots that carry sensory information. Selective means that they will cut those that seem to be carrying information from certain regions of the body. The long-used procedure is called partial dorsal root rhizotomy where they cut only part of each root. It has been used to help reduce pain but the efficacy of such procedures for reducing neuropathic pain is still controversial and unreliable.

Wise.

[Zoso]

Dr. Young,

Would you recommend the procedure as an option at all, because it was suggested to me recently. What are the negative aspects? I understand any cutting of nerves is serious but I am willing to try almost anything to stop the pain.

[adi chicago]

Rhizotomy refers to cutting of spinal roots. Dorsal root rhizotomy refers to the cutting of dorsal roots that carry sensory information. Selective means that they will cut those that seem to be carrying information from certain regions of the body. The long-used procedure is called partial dorsal root rhizotomy where they cut only part of each root. It has been used to help reduce pain but the efficacy of such procedures for reducing neuropathic pain is still controversial and unreliable.

Wise.
thank you sir a neuro surgeon from romania tried to convince me to have such a procedure and my neuropain will be history.agrrrrrrrr.......pain and sci ,

[metronycguy]

zoso , you have not been injured 2 years yet, i wouldn't consider that good advice, i hope that is not your pain management doc giving you that advice

[Wise Young]

Dr. Young,

Would you recommend the procedure as an option at all, because it was suggested to me recently. What are the negative aspects? I understand any cutting of nerves is serious but I am willing to try almost anything to stop the pain.

Dear Zoso,

Selective rhizotomy is controversial not only because it is ineffective for pain but because it may aggravate existing pain or produce new pain. Neuropathic pain is sometimes called deafferentation pain, i.e. pain resulting from removal of inputs. For example, avulsion of spinal dorsal roots causes pain because it causes deafferentation. When one removes input to the spinal cord, denervating sensory neurons in the spinal cord, local axons in the spinal cord sprout to replace lost connections. These new synapses may be the cause of neuropathic pain.

The more effective and proven procedure is one called dorsal root entry zone (DREZ) lesions. Instead of just cutting the dorsal roots, the DREZ cauterizes (burns) the dorsal root entry zone (the part of the spinal cord at the entry of the dorsal root). This either eliminates or reduces neuropathic pain in a majorty of patients. Note, however, that this is effective mainly in patients who show neuropathic pain that can be attributed to a given dermatome (the area that is innervated by one or more dorsal roots). I can write more but I think that I am going to move this to the pain forum so that more people who may have had experience with DREZ can chime in.

http://content.karger.com/ProdukteDB/produkte.asp?Doi=99917

Wise.

[Zoso]

The selective rhizotomy was mentioned by an orthopaedic surgeon who is performing a procedure on my hip soon. I have scheduled an appointment with a pain specialist soon after and was trying to learn as much as I could. I would think my pain could be attributed to one or two dermatomes, as it is primarily my left foot. I will be sure to ask about it at my appointment.