Tight adhesions after spinal cord stimulation observed during dorsal root entry zone lesioning for pain after spinal root avulsion: illustrative cases

Author:

Kimoto Yuki1,Hosomi Koichi12,Ohnishi Yuichiro13,Emura Takuto1,Mori Nobuhiko12,Nishi Asaya1,Yanagisawa Takufumi14,Tani Naoki1,Oshino Satoru12,Saitoh Youichi56,Kishima Haruhiko12

Affiliation:

1. Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

2. Center for Pain Management, Osaka University Hospital, Suita, Osaka, Japan

3. Department of Neurosurgery, Osaka Gyoumeikan Hospital, Osaka, Japan

4. Institute for Advanced Co-Creation Studies, Osaka University, Suita, Osaka, Japan

5. Osaka University Graduate School of Engineering Science, Toyonaka, Osaka, Japan; and

6. Tokuyukai Rehabilitation Clinic, Toyonaka, Osaka, Japan

Abstract

BACKGROUND Patients often experience strong shooting pains after spinal root avulsion. The efficacy of spinal cord stimulation (SCS) for this type of pain is inconsistent; however, dorsal root entry zone (DREZ) lesioning (DREZ-lesion) has often proven to be an effective treatment modality. The authors report two cases in which DREZ-lesion was performed to treat pain after spinal root avulsion after implantation of SCS, but the operations were challenging due to strong adhesions. OBSERVATIONS The authors present two cases of patients with pain after spinal root avulsion in whom SCS implantation was only temporarily effective. Patients complained of persistent and paroxysmal shooting pains in the upper extremities. SCS removal and DREZ-lesion were performed, but adhesions in the epidural and subdural space contacting the leads were strong, making it difficult to expose the DREZ. LESSONS Although adhesions around the spinal cord can be caused by trauma, the authors believe that in these cases, the adhesions could have been caused by the SCS leads. There are few previous reports confirming the efficacy of SCS in treating pain after spinal root avulsion; therefore, caution is required when considering SCS implantation.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Management Science and Operations Research,Mechanical Engineering,Energy Engineering and Power Technology

Reference33 articles.

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4. Study of the dorsal root entry zone. Implications for pain surgery;Sindou M,1972

5. Phantom pain relief by focal destruction of the substantia gelatinosa of Rolando;Nashold BS Jr,1976

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