Sitthinamsuwan Bunpot, Ounahachok Tanawat, Pumseenil Sawanee, Nunta-Aree Sarun
Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, 10700, Bangkok, Thailand.
Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand.
Neurosurg Rev. 2025 Jan 2;48(1):17. doi: 10.1007/s10143-024-03136-y.
Treatment of neuropathic pain in patients with spinal cord injury (SCI) and cauda equina injury (CEI) remains challenging. Dorsal root entry zone lesioning (DREZL) or DREZotomy is a viable surgical option for refractory cases. This study aimed to compare DREZL surgical outcomes between patients with SCI and those with CEI and to identify predictors of postoperative pain relief. We retrospectively analyzed 12 patients (6 with SCI and 6 with CEI) with intractable neuropathic pain who underwent DREZL. The data collected were demographic characteristics, pain distribution, and outcomes assessed by numeric pain rating scores. Variables and percentages of pain improvement at 1 year and long-term were statistically compared between the SCI and CEI groups. The demographic characteristics and percentage of patients who experienced pain improvement at 1 year postoperatively did not differ between the groups. Compared with the SCI group, the CEI group presented significantly better long-term pain reduction (p = 0.020) and favorable operative outcomes (p = 0.015). Patients with border zone pain had significantly better long-term pain relief and outcomes than did those with diffuse pain (p = 0.008 and p = 0.010, respectively). Recurrent pain after DREZL occurred in the SCI group but not in the CEI group. DREZL provided superior pain relief in patients with CEI. The presence of border zone pain predicted favorable outcomes. CEI patients or SCI patients with border zone pain are good surgical candidates for DREZL, whereas SCI patients with below-injury diffuse pain are poor candidates.
脊髓损伤（SCI）和马尾神经损伤（CEI）患者的神经性疼痛治疗仍然具有挑战性。背根入髓区毁损术（DREZL）或背根入髓区切开术是难治性病例的一种可行手术选择。本研究旨在比较SCI患者和CEI患者的DREZL手术结果，并确定术后疼痛缓解的预测因素。我们回顾性分析了12例接受DREZL治疗的顽固性神经性疼痛患者（6例SCI患者和6例CEI患者）。收集的数据包括人口统计学特征、疼痛分布以及通过数字疼痛评分评估的结果。对SCI组和CEI组1年及长期疼痛改善的变量和百分比进行统计学比较。两组之间的人口统计学特征以及术后1年疼痛改善患者的百分比没有差异。与SCI组相比，CEI组长期疼痛减轻更显著（p = 0.020），手术效果更好（p = 0.015）。边缘区疼痛患者的长期疼痛缓解和手术效果明显优于弥漫性疼痛患者（分别为p = 0.008和p = 0.010）。DREZL术后复发性疼痛出现在SCI组，而CEI组未出现。DREZL为CEI患者提供了更好的疼痛缓解。边缘区疼痛的存在预示着良好的手术效果。CEI患者或有边缘区疼痛的SCI患者是DREZL的良好手术候选者，而损伤平面以下有弥漫性疼痛的SCI患者则是较差的候选者。
