Changes in Spontaneous Dorsal Horn Potentials after Dorsal Root Entry Zone Lesioning in Patients with Pain after Brachial Plexus Avulsion

Abstract

OBJECTIVES: This study investigated spontaneous dorsal horn potentials in patients with pain after brachial plexus avulsion and determined the effect of dorsal root entry zone (DREZ) lesioning on these potentials and on pain levels. METHODS: Electrospinography (ESG) recordings were undertaken in seven patients using a noninvasive electrocorticography strip electrode. Measurements were taken from the DREZ on the intact side of the spinal cord before lesioning of the injured DREZ and from the injured DREZ before and after lesioning. RESULTS: DREZ lesioning had a significant positive effect on pain at 12 months postoperatively. At 15.0 Hz, the mean ESG power from the injured DREZ before lesioning was significantly higher than that from the intact DREZ. In addition, the mean ESG power from the injured DREZ after successful DREZ lesioning was significantly lower than that from the intact DREZ and that from the injured DREZ before lesioning. CONCLUSIONS: The ESG power from the injured DREZ increases in patients with pain after brachial plexus avulsion compared with that of the intact DREZ; this increase is reduced by successful DREZ lesioning.

Keywords

BRACHIAL PLEXUS AVULSION DORSAL HORN SPONTANEOUS POTENTIAL DORSAL ROOT ENTRY ZONE LESION POWER SPECTRAL ANALYSIS STRIP ELECTRODE

References

Carlstedt

Anand

Hallin

: Spinal nerve root repair and reimplantation of avulsed ventral roots into the spinal cord after brachial plexus injury. J Neurosurg 2000; 93 (suppl): 237–247.

Aichaoui

Mertens

Sindou

: Dorsal root entry zone lesioning for pain after brachial plexus avulsion: results with special emphasis on differential effects on the paroxysmal versus the continuous components. A prospective study in a 29-patient consecutive series. Pain 2011; 152: 1923–1930.

Samii

Bear-Henney

Lüdemann

: Treatment of refractory pain after brachial plexus avulsion with dorsal root entry zone lesions. Neurosurgery 2001; 48: 1269–1277.

Sindou

Blondet

Emery

: Microsurgical lesioning in the dorsal root entry zone for pain due to brachial plexus avulsion: A prospective series of 55 patients. J Neurosurg 2005; 102: 1018–1028.

Prestor

: Microcoagulation of junctional dorsal root entry zone is effective treatment of brachial plexus avulsion pain: long-term follow-up study. Croat Med J 2006; 47: 271–278.

Frank

Fuortes

: Potentials recorded from the spinal cord with microelectrodes. J Physiol 1955; 130: 625–654.

Knabl

Witschi

Hösl

: Reversal of pathological pain through specific spinal GABA_A receptor subtypes. Nature 2008; 451: 330–334.

Loeser

Ward

Jr : Some effects of deafferentation on neurons of the cat spinal cord. Arch Neurol 1967; 17: 629–636.

Jeanmonod

Sindou

Magnin

: Intra-operative unit recordings in the human dorsal horn with a simplified floating microelectrode. Electroencephalogr Clin Neurophysiol 1989; 72: 450–454.

10.

Guenot

Bullier

Rospars

: Single-unit analysis of the spinal dorsal horn in patients with neuropathic pain. J Clin Neurophysiol 2003; 20: 143–150.

11.

Melzack

Wall

: Pain mechanisms: A new theory. Science 1965; 150: 971–979.

12.

Lin

Kwan

: Post-section recruitment of epileptiform discharges in electrocorticography during callosotomy in 48 patients with Lennox—Gastaut syndrome. J Clin Neurosci 2012; 19: 388–393.

13.

Sindou

Fischer

Mansuy

: Posterior spinal rhizotomy and selective posterior rhizidiotomy. In: Progress in Neurological Surgery, Vol 7 ( Krayenbuhl

Maspes

Sweet

, eds). Basel: Karger, 1993: pp 201–250.

14.

Sindou

Mertens

Wael

: Microsurgical DREZotomy for pain due to spinal cord and/or cauda equina injuries: long-term results in a series of 44 patients. Pain 2001; 92: 159–171.

15.

Welch

: The use of fast Fourier transform for the estimation of power spectra: A method based on time averaging over short, modified periodograms. IEEE Transactions on Audio Electroacoustics 1967; AU-15: 70–73.

16.

Ovelmen-Levitt

: Abnormal physiology of the dorsal horn as related to the deafferentation syndrome. Appl Neurophysiol 1988; 51: 104–116.

17.

Prestor

: Microsurgical junctional DREZ coagulation for treatment of deafferentation pain syndromes. Surg Neurol 2001; 56: 259–265.

18.

Edgar

Best

Quail

: Computer-assisted DREZ microcoagulation: posttraumatic spinal deafferentation pain. J Spinal Disord 1993; 6: 48–56.

19.

Falci

Best

Bayles

: Dorsal root entry zone microcoagulation for spinal cord injury-related central pain: operative intramedullary electrophysiological guidance and clinical outcome. J Neurosurg 2002; 97 (suppl): 193–200.

20.

Dalal

Tata

Allègre

: Spontaneous activity of rat dorsal horn cells in spinal segments of sciatic projection following transection of sciatic nerve or of corresponding dorsal roots. Neuroscience 1999; 94: 217–228.

21.

Rodríguez

Hernàndez-Lemus

Itzà-Ortiz

: Multichannel detrended fluctuation analysis reveals synchronized patterns of spontaneous spinal activity in anesthetized cats. PLoS One 2011; 6: e26449.

22.

Manjarrez

Rojas-Piloni

Jimenez

: Modulation of synaptic transmission from segmental afferents by spontaneous activity of dorsal horn spinal neurones in the cat. J Physiol 2000; 529: 445–460.

23.

Sindou

Jeanmonod

Mertens

: Ablative neurosurgical procedures for the treatment of chronic pain. Neurophysiol Clin 1990; 20: 399–423.