Posted 30 August 2007 - 04:22 AM
I just wanted to clarify one key aspect of Wheelie-Bar's surgery. This surgery is CA-DREZ not RF-DREZ where the CA stands for computer-assisted. Here's an abstract from a presentation given at a 2002 ASIA conference. If you want to get technical look up Journal of Neurosurgery: Spine/Volume 97/September 2002;193-200. This surgery is definitely not for everyone (note the reference to deafferentiation pain) and has major risks (can move the level of injury upward). However as the data improves there is great promise for this surgery to resolve lower thoracic NP.
Surgical Treatment of Spinal Cord Injury (SCI) Pain Using A New Technique of lntramedullary Electrical Analysis
S. Falci, MD; L. Best, PhD; D Lammertse, MD; and C Starnes, RN
Craig Hospital, Englewood, CO
Over the last 40 years, the literature reports the prevalence of severe or disabling chronic pain after spinal cord injury (SCI) to range from 18 to 63 percent. Surgical treatment in the dorsal root entry zone (DREZ) of the spinal cord to relieve these central deafferentation pains has historically resulted in modest outcomes. The literature suggests that approximately 50 to 100 percent of pain relief is experienced in approximately 50 percent of patients with severe or disabling chronic pain. A new surgical technique utilizing spontaneous intramedullary recordings as well as intramedullary recordings during transmission of stimuli in a C-fiber frequency to guide DREZ lesioning for these pains is reported. Thirty-six patients with SCI and intractable central deafferentation pains underwent DREZ radiofrequency heat lesioning betwen 1993-1998. In 11 of these patients, spontaneous intramedullary electrical recordings alone were used to guide DREZ lesioning; 63 percent of these patients achieved 100 percent pain relief and 82 percent achieved 50 to 100 percent relief, demonstrating significant improvement from the literature. In 25 patients, spontaneous intramedullary recordings were used in conjunction with recordings during C-fiber stimulus to guide DREZ lesioning. Eighty-four percent of these patients achieved 100 percent pain relief. In the last 10 of these patients, wherein more experience with this technique was gained, all achieved 100 percent pain relief. Pain severity was graded usinq a visual analogue or 10-point scale. Follow-up was by personal interview, telephone call and/or questionnaire, and ranged from three months to five years. This technique allowed for somatotopic mapping of the DREZ of the spinal cord with regard to generation of central deafferentation pain. In general, the L1 DREZ correlates with pain in the feet; the T11 and T12 DREZs with pain in the lower extremities; the T8, T9 and T10 DREZs with pain in the buttock, and DREZs more cephalad with pain in any regions more caudally. The anatomy of the sympathetic nervous system correlates well with such mapping, implicating its involvement.
"We are beings for themselves trying to be beings in themselves." J.P. Sartre
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I just like it when the stakes aren't so high. I have feeling as of now.....but if a scalpel went to deep or swelling or what ever made my sense of feeling go away.....I could REALLY be subject to problems with pressure sores!
