脊髓背根入髓区毁损术治疗脊髓和马尾神经损伤后疼痛

目的 探讨脊髓和马尾神经损伤后疼痛的神经外科治疗方法、效果和安全性.方法 脊髓和马尾神经损伤后疼痛患者14例,年龄28～72岁,病程8个月-28年;疼痛位于下肢感觉减退和缺失区,为烧灼、压榨或痉挛样疼痛,视觉模拟疼痛评分(Visual analogy scale,VAS)8～10分;均伴有不同程度的下肢肌力下降.14例患者共行脊髓背根入髓区(dorsal root entry zone,DREZ)毁损术15次.结果 随访3个月-3年.6例疼痛消失,5例疼痛明显减轻,停用或少量使用镇痛剂,VAS 2～4分;3例疼痛无明显改善.所有病例无严重手术并发症.结论 DREZ毁损术对脊髓和马尾神经损伤后慢性神经病理性疼痛安全有效.

Lesion of dorsal root entry zone for pain due to spinal cord and cauda equina injuries

Objective To discuss the neurosurgical management for chronic neuropathic pain due to spinal cord and cauda equina injuries. Methods There were 14 patients of chronic neuropathic pain due to spinal cord and cauda equina injuries. The age was between 28 to 72 yrs old. The history was between 8 months to 28 years. The distribution of pain was confined to hypoesthetic and anesthetic areas. Pain was often described as severe burning, crushing or cramping in character. The Visual Analogy Seale was between 8 to 10. They all had complete or incomplete paraplegia. A total of 15 microsurgical dorsal root entry zoneotomy were performed on these patients. Results Postoperative follow - up were 3 months to 3 years. Six patients were free of pain with complete withdrawal of narcotics. Five patients had great pain relief whose VAS was 2 to 4. Among them, 3 were free of narcotics, 2 reduced the dose of narcotics. Three were inefficient. No severe complications occurred. Conclusion Microsurgical dorsal root entry zoneotomy was effective for treating chronic neuropathic pain due to spinal cord and cauda equina injuries.