| New Technical Considerations about MicroDERZotomy for Paraplegic Pain due to Conus Medullaris Injury |
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Tae-Koo Cho, Young-Jin Kim, Seong-Hoon Oh, Kwang-Myung Kim, Young-Soo Kim |
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Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea |
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| Abstract |
Objective
DREZ lesioning and microDREZotomy (MDT) are main treatments for the control of paraplegic pain. But their favorable results do not reach to 50-60% of pain control of operating cases. Authors propose several delicate surgical techniques for improvement of pain control during MDT.
Methods
Fifteen patients who had paraplegic pain due to injury of thoracolumbar junction with conus medullaris injury were undertaken MDT from Dec. 2003 to Jun. 2005. Laminectomies was performed from T9-L1 including injured level. After dural opening, arachnoidal dissection was completely done as possible as we could. From 2 level above injured spinal cord, MDT was performed. Injured level showed distorted feature with severe adhesion, scar reaction with or without syrinx. If possible, delicate microdissection for adhesive scar and distored spinal posterior rootelts, and cutting the injured posterior rootlets followed by MDT on injured level was performed along the imaginary posterolateral sulcus. If syrinx was found, incision on the imaginary posterior lateral sulcus and syrinx should be drained, after then MDT was performed on incison plane. If the above procedures were not possible due to severe atrophy and distortion, cordectomy was considered.
Results
Immediately postoperative results showed over 90% of pain control of preoperative complaints. During follow-up period, one male patient complained partial recurrence of preoperative pain. But pain was subsided with administration of gabapentine. There was no morbidity and mortality.
Conclusion
Author proposes delicate manipulations of injured spinal cord might improve surgical results of MDT for paraplegic pain due to conus medullaris injury. |
| Key Words:
DREZ lesioning, MicroDREZotomy, Paraplegic pain. |
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