Visnjevac Ognjen, Ma Frederick, Abd-Elsayed Alaa
Department of Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Cleveland Clinic Canada, Toronto, Ontario, Canada.
J Pain Res. 2021 Jan 7;14:1-12. doi: 10.2147/JPR.S255726. eCollection 2021.
The purpose of this translational review was to provide evidence to support the natural evolution of the nomenclature of neuromodulatory and neuroablative radiofrequency lesions for pain management from lesions of individualized components of the linear dorsal afferent pathway to "Dorsal Root Entry Zone Complex (DREZC) lesions." Literature review was performed to collate anatomic and procedural data and correlate these data to clinical outcomes. There is ample evidence that the individual components of the DREZC (the dorsal rami and its branches, the dorsal root ganglia, the dorsal rootlets, and the dorsal root entry zone) vary dramatically between vertebral levels and individual patients. Procedurally, fluoroscopy, the most commonly utilized technology is a 2-dimensional x-ray-based technology without the ability to accurately locate any one component of the DREZC dorsal afferent pathway, which results in clinical inaccuracies when naming each lesion. Despite the inherent anatomic variability and these procedural limitations, the expected poor clinical outcomes that might follow such nomenclature inaccuracies have not been shown to be prominent, likely because these are all lesions of the same anatomically linear sensory pathway, the DREZC, whereby a lesion in any one part of the pathway would be expected to interrupt sensory transmission of pain to all subsequent more proximal segments. Given that the common clinically available tools (fluoroscopy) are inaccurate to localize each component of the DREZC, it would be inappropriate to continue to erroneously refer to these lesions as lesions of individual components, when the more accurate "DREZC lesions" designation can be utilized. Hence, to avoid inaccuracies in nomenclature and until more accurate imaging technology is commonly utilized, the evidence herein supports the proposed change to this more sensitive and inclusive nomenclature, "DREZC lesions."
本转化性综述的目的是提供证据，以支持用于疼痛管理的神经调节性和神经毁损性射频损伤的命名从线性背侧传入通路的各个组成部分的损伤自然演变为“背根入髓区复合体（DREZC）损伤”。进行文献综述以整理解剖学和操作数据，并将这些数据与临床结果相关联。有充分证据表明，DREZC的各个组成部分（背支及其分支、背根神经节、背根小支和背根入髓区）在不同椎体水平和个体患者之间存在显著差异。在操作上，荧光透视法是最常用的技术，它是一种基于二维X射线的技术，无法准确定位DREZC背侧传入通路的任何一个组成部分，这导致在命名每个损伤时出现临床误差。尽管存在固有的解剖学变异性和这些操作限制，但尚未显示出这种命名不准确可能导致的预期不良临床结果很突出，可能是因为这些都是同一解剖学线性感觉通路DREZC的损伤，因此该通路中任何一个部位的损伤都有望中断疼痛向所有后续更近端节段的感觉传递。鉴于临床上常用的工具（荧光透视法）无法准确定位DREZC的每个组成部分，当可以使用更准确的“DREZC损伤”命名时，继续错误地将这些损伤称为各个组成部分的损伤是不合适的。因此，为避免命名不准确，在更准确的成像技术普遍应用之前，本文的证据支持采用这种更敏感和更具包容性的命名“DREZC损伤”的提议变更。
