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Thread: DREZ-? for Dr. Young

  1. #1

    DREZ-? for Dr. Young

    What is your opinion of the DREZ procedure? If someone had it done, would it have any impact on their chance for a future cure? Thanks for your input.

  2. #2
    Phillis, in my opinion, the DREZ procedure should be a procedure of last resort because it is destructive. I also think that it should be restricted to the localized pain. Wise.

  3. #3
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    Originally posted by Phillis:

    What is your opinion of the DREZ procedure? If someone had it done, would it have any impact on their chance for a future cure? Thanks for your input.
    Ive had the DREZ over 7 yrs now with 100% relief of pain. I had pain from the waist down. It was the best thing I have ever done. Contact me for info if you want Sirdzoker@aol.com

  4. #4
    Senior Member alan's Avatar
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    In other words, with my all over pains, I wouldn't be a candidate for this.

  5. #5
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    Alan, you could be a good candidate. My pain was from the waist down. You really need the advice of more than one doctor in regards to this type of surgery. You also need the advice from a doctor who has had sucessful results of the drez. Also the patients who have had it done with good results, like myself. I recommend it any day over all the narcotics the Drs are giving for this pain. Because anyone knows who suffers from it knows that these meds do not deaden the pain, they only deaden the patient so they can accept pain. Just food for thought.

  6. #6
    Here are some recent articles on the subject:


    • Burchiel KJ and Hsu FP (2001). Pain and spasticity after spinal cord injury: mechanisms and treatment. Spine 26:S146-60. Summary: STUDY DESIGN: A comprehensive survey of literature on the proposed mechanisms and treatment of pain and spasticity after spinal cord injury (SCI) was completed. OBJECTIVES: To define the current understanding of these entities and to review various treatment options. SUMMARY OF BACKGROUND DATA: The neurophysiologic basis of spasticity after SCI is well established. The mechanism of neuropathic pain after SCI remains conjectural, although considerable new data, much of it from animal models, now add to our understanding of this condition. METHODS: A comprehensive search and review of the published literature was undertaken. RESULTS: Treatment options for spasticity are effective and include oral medication (baclofen, tizanidine), intrathecal baclofen, and rarely, surgical rhizotomy or myelotomy. Selected patients with post-SCI pain can respond to surgical myelotomy (DREZ lesions) or intrathecal agents (e.g., morphine + clonidine), but the majority continue to suffer. CONCLUSIONS: Medical and surgical treatments for spasticity are established and highly successful. Management of post-SCI pain remains a clinical challenge, as there is no uniformly successful medical or surgical treatment. Department of Neurological Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA. burchiek@ohsu.edu

    • Mertens P and Sindou M (2000). [Surgery in the dorsal root entry zone for treatment of chronic pain]. Neurochirurgie 46:429-46. Summary: Microsurgical drezotomy (MDT) consists of an incision and bipolar coagulations performed ventro-laterally in the Dorsal Root Entry Zone (DREZ) at the entrance of the rootlets into the dorso-lateral sulcus. The lesion is directed at 35 ventro-medially, and to 2-3 mm deep according to the pre-operative neurological status and the desired effects. MDT i) interrupts the small (nociceptive) fibres regrouped laterally and the large (myotatic) afferents which runs centrally, whilst sparing part of the large medial (lemniscal) fibres, ii) destroys the (excitatory) medial part of the Lissauer's tract, iii) and the cells of the dorsalmost layers of the dorsal horn, which can be the site of hyperactivity, as we were able to record in patients with deafferentation pain. Best indications are: i) well-localized cancer pain, such as Pancoast syndrome; ii) neuropathic pain due to: brachial plexus injuries; cauda equina and/or spinal cord lesions (especially for pain corresponding to segmental lesions); peripheral nerve injuries, amputation, herpes zoster - especially when the predominant component of pain is of the paroxysmal type and/or corresponds to provoked hyperalgesia/allodynia); iii) excess of spasticity, especially when associated with severe pain. Service de Neurochirurgie A, Hopital Neurologique et Neurochirurgical P. Wertheimer, Universite de Lyon, 59, boulevard Pinel, 69003 Lyon.

    • Sindou M (1995). Microsurgical DREZotomy (MDT) for pain, spasticity, and hyperactive bladder: a 20-year experience. Acta Neurochir (Wien) 137:1-5. Summary: Since 1972, micro-DREZ-tomy has been performed in 367 patients: with cancer pain in 81, neurogenic pain in 139, hyperspasticity in 135, and hyperactive neurogenic bladder in 12. MDT consists of an incision and bipolar coagulations performed ventro-laterally in the Dorsal Root Entry Zone (DREZ) at the entrance of the rootlets into the dorso-lateral sulcus. The lesion is directed at 45 degrees ventro-medially, and 2-3 mm deep according to the pre-operative neurological status and the desired effects. MDT 1 degree interrupts the small (nociceptive) fibres regrouped laterally and the large (myotatic) afferents which runs centrally, whilst sparing part of the large medial (lemniscal) fibres. 2 degrees destroys the (excitatory) medial part of the Lissauer's tract, 3 degrees and the cells of the dorsalmost layers of the dorsal horn, which can be the site of hyperactivity, as we were able to record in patients with deafferentation pain. Best indications are: 1) well localized cancer pain, such as Pan-coast syndrome; 2) neuropathic pain due to: brachial plexus injuries, cauda equina and/or spinal cord lesions especially for pain corresponding to segmental lesions, peripheral nerve injuries-amputation-herpes zoster-(especially when the predominant component of pain is of the paroxysmal type and/or corresponds to provoked hyperalgesia/allodynia); 3) excess of spasticity and 4) neurogenic hyperactive bladder. Department of Neurosurgery, Neurological Hospital P. Wertheimer, University of Lyon, France.

    • Sindou M, Mertens P and Wael M (2001). Microsurgical DREZotomy for pain due to spinal cord and/or cauda equina injuries: long-term results in a series of 44 patients. Pain 92:159-71. Summary: According to the literature estimations, 10-25% of patients with spinal cord and cauda equina injuries eventually develop refractory pain. Due to the fact that most classical neurosurgical methods are considered of little or no efficacy in controlling this type of pain, the authors had recourse to microsurgery in the dorsal root entry zone (DREZ). This article reports on the long-term results of the microsurgical approach to the dorsal root entry zone (DREZotomy) in a series of 44 patients suffering from unbearable neuropathic pain secondary to spine injury. The follow-up ranged from 1 to 20 years (6 years on average). The series includes 25 cases with conus medullaris, 12 with thoracic cord, four with cauda equina and three with cervical cord injuries. Surgery was performed in 37 cases at the pathological spinal cord levels that corresponded to the territory of the so-called 'segmental pain', and in seven cases, on the spinal cord levels below the lesion for 'infralesional pain' syndromes. The post-operative analgesic effect was considered to be 'good' when a patient's estimation of pain relief exceeded 75%, 'fair' if pain was reduced by 25-75%, and 'poor' when the residual pain was more than 75% of preoperative estimations. Immediate pain relief was obtained in 70% of patients and was long-lasting in 60% of the total series. The results varied essentially according to the distribution of pain. Good long-term results were obtained in 68% of the patients who had a segmental pain distribution, compared with 0% in patients with predominant infralesional pain. Regarding pain characteristics, a good result was obtained in 88% of the cases with predominantly paroxysmal pain, compared with 26% with continuous pain. There were no perioperative mortalities. Morbidity included cerebrospinal fluid leak (three patients), wound infection (two patients), subcutaneous hematoma (one patient) and bacteremia (in one patient). The above data justify the inclusion of DREZ-lesioning surgery in the neurosurgical armamentarium for treating 'segmental' pain due to spinal cord injuries. Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, University of Lyon, 69003, Lyon, France. marc.sindou@chu-lyon.fr

    • Spaic M, Markovic N and Tadic R (2002). Microsurgical DREZotomy for pain of spinal cord and Cauda equina injury origin: clinical characteristics of pain and implications for surgery in a series of 26 patients. Acta Neurochir (Wien) 144:453-62. Summary: The result of the DREZotomy procedure used for the treatment of chronic intractable neuropathic pain caused by injuries at the T9-L4 spine level in 26 patients has been reported. For the purpose of identifying the most favorable pain pattern for DREZ surgery we retrospectively analyzed the effectiveness of surgical treatment on different forms of pain in the follow-up period of 13-50 months, 37 months on average. All pain forms were classified according to subjective sensory pain expression including the rhythm and topography of the pain. Three groups of pain were formed according to subjective sensory equivalents: pain of thermal quality (burning, boiling, baking, warm etc.), pain of mechanical-nonthermal quality (shooting, cutting, stabbing, sharp, incisive, cramping, constriction, distraction, throbbing etc.). The third group was the combination of the previous two. Success in pain relief has been defined as a 50% or greater reduction in pain after surgery such that pain no longer interferes with patient activities of daily living and sleeping pattern and no longer requires routine analgesic pain medication. Our results revealed that the pain of mechanical-nonthermal nature and intermittent rhythm, confined to segmental topography was the most responsive to the DREZ surgical treatment so that 90% patients suffering from this pain pattern experienced a good long-term pain relief (70% had complete long term pain relief). Neuropathic pain of thermal quality with the diffuse infralesional distribution and steady rhythm was the most resistant to the DREZ surgical treatment: neither patient had long-term relief of this pain pattern. In the group of patients suffering from pain consisting of combined mechanical and thermal sensory components with confined pain territory, 75% experienced a good long-term pain relief (50% had complete long-term pain relief). Immediate pain relief was obtained in 88% of patients and was long lasting in 69% of the total series. Our results pointed to confined territory, intermittent rhythm and mechanical nature of the pain as the most relevant predictors of the expected pain relief achieved by the DREZ surgery. Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia, Yugoslavia.

  7. #7
    Junior Member ARISAR's Avatar
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    I am so glad that I found this link in New Mobility magazine. I have had chronic pain for the past 16 years and I have not been able to find relief. I was prescribed Elavil (low dose) for three years, but it made me numb and sleepy and I couldn't function in school. Since then (13 years), I haven't taken anything except something over the counter at times when I couldn't sleep. The burning, stinging hasn't gone away at all, but I have noticed that as I am aging I am getting other pains and at times it is unbearable. I have had a few doctors recommend DREZ and my reasons for not having the procedure done were more based on sensation and balance and less on cure. I wanted to know how much of what I have would be lost with the procedure or is there any way to know?

    What else to you suggest for pain management? I have done well basically ignoring it for all this time, but there are really times that I need relief.

  8. #8
    Senior Member alan's Avatar
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    Originally posted by Sir Dzoker:

    Alan, you could be a good candidate. My pain was from the waist down. You really need the advice of more than one doctor in regards to this type of surgery. You also need the advice from a doctor who has had sucessful results of the drez. Also the patients who have had it done with good results, like myself. I recommend it any day over all the narcotics the Drs are giving for this pain. Because anyone knows who suffers from it knows that these meds do not deaden the pain, they only deaden the patient so they can accept pain. Just food for thought.
    My pains are from the upper chest and back down.

  9. #9
    Quote Originally Posted by Sir Dzoker
    Ive had the DREZ over 7 yrs now with 100% relief of pain. I had pain from the waist down. It was the best thing I have ever done. Contact me for info if you want Sirdzoker@aol.com
    Hi I don't know if u got my first message?I would like learn more of
    DREZ.And where it's possible to take one.I feel I have nothing to loose.
    They have giving up on me here in Norway.My injured is from t9-10 comlete.My pain is so terrible from waist down.It's like my legs is
    wrapped up in barbed wire.The only thing they can give me is meds,but they
    have not much effect on me anymore.I'm longing for a long good sleep.It's been a while.I tried to send u a mail,but i didn't work out.If u can't help me,is there anybody else who can?I have suffer enough now in the past 8 years since my injury.

  10. #10
    http://www.newmobility.com/review_ar...&action=browse

    "The Duke DREZ procedure that Snow contemplated simply burned the sensory nerves two levels above the original injury and one level below it. This procedure was eventually undertaken and improved upon by Craig Hospital's Dr. Robert Edgar, now retired, and Dr. Scott Falci."

    Contact Dr. Scott Falci at Craig Hospital http://www.craighospital.com/ in Denver (actually Englewood, Denver suburb), Colorado.

    Scott Falci, M.D., Neurosurgeon
    Charlotte Starnes, R.N. 303-761-5281
    CStarnes@craighospital.org
    Last edited by cass; 08-07-2006 at 08:30 PM.

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