Dorsal root entry zone lesions for conus medullaris root avulsions

We have found dorsal root entry zone (DREZ) lesions to be an effective treatment of chronic deafferentation pain in patients who have had avulsions of the dorsal rootlets from the spinal cord. Eight patients were operated in whom chronic pain of the lower extremity resulted from dorsal root avulsions from the conus medullaris. In 7 of the 8 patients, the mechanism of injury was a motor vehicle accident; all 7 sustained severe pelvic trauma. Seven of the 8 patients remained pain-free, off all narcotics, with an average follow-up of 33 months. All patients had DREZ lesions of the conus performed by radiofrequency techniques.     

Successful treatment of phantom pain with dorsal root entry zone coagulation

We studied 22 patients with amputation due to trauma, gangrene, or cancer. All developed postamputation pain, underwent a dorsal root entry zone (DREZ) procedure, and were followed from 6 months to 4 years after surgery. Overall, only 8 (36%) of these 22 patients had pain relief. However, good results were obtained in 6 (67%) of 9 patients with phantom pain alone, and in 5 (83%) of 6 patients with traumatic amputations associated with root avulsion. Poor results were obtained in patients with both phantom and stump pain, or stump pain alone. The DREZ procedure has a well-defined, but limited role in the treatment of postamputation pain.     

Anatomic examination of human dorsal root entry zone lesions

The anatomic delineation of radiofrequency dorsal root entry zone lesions using the Nashold thermocouple electrode is presented. The sharply delineated lesions involve a major portion of the dorsal horn of the spinal cord including Rexed's lamina V and part of VI. The extent of these lesions is appropriate, based on the currently understood mechanisms of spinal generators of chronic deafferentation pain.     

Pain control with laser-produced dorsal root entry zone lesions

Pain relief was evaluated in 40 patients with various types of deafferentation pain that were treated with dorsal root entry zone (DREZ) lesions produced with microsurgical lasers. Good long-term pain relief was evident in some paraplegics and in all patients with brachial plexus avulsion. Several other small subgroups of patients benefited from laser DREZ lesions as well. Pain associated with arachnoiditis and peripheral nerve injury or neuropathy did not respond to laser DREZ lesioning. Based upon the smaller lesion dimensions produced with the lasers, it is proposed that interruption of impulses in the tract of Lissauer may be a mechanism of pain control in patients that responded to laser DREZ lesions.     

Neurosurgical technique of the dorsal root entry zone operation

The dorsal root entry zone operation was introduced in 1976 to relieve the pain of brachial plexus avulsion. Since then it has been applied to pain treatment in paraplegia, postherpetic pain, phantom limb pain and other types of of deafferentation pain. Over 400 operations have been done at the Duke University Medical Center with overall good results in 60% of pain patients.     

Dorsal root entry zone lesions in the treatment of pain following brachial plexus avulsion, spinal cord injury and herpes zoster

This paper details the long-term results in patients treated with dorsal root entry zone (DREZ) lesions for the treatment of pain following brachial plexus avulsion, spinal cord injury, and herpes zoster. With our current operative technique, 82% of patients with brachial plexus avulsion injuries were afforded long-term pain relief. Patients with pain confined to dermatomes just below the level of spinal injury also did well with DREZ lesions, although the results were less good in patients with diffuse pain or with sacral pain. The postoperative results in patients with postherpetic pain were disappointing.     

Clinical review of nucleus caudalis dorsal root entry zone lesions for facial pain

Twenty-seven patients with intractable facial pain underwent dorsal root entry zone thermocoagulation lesion of the nucleus caudalis of the spinal trigeminal nucleus. Retrospective review revealed a success rate of 85% in the immediate postoperative period declining to 52% on subsequent follow-up. The best results were in the subgroup of patients with postherpetic neuralgia, of which 67% achieved definite relief. There tended to be some correlation of satisfactory results and pain quality as well as extent of pain along trigeminal territory. The operative morbidity was low although most patients were observed to have a mild transient ipsilateral dysmetria.     

Experimental anatomical considerations of the dorsal root entry zone lesions for pain relief

Dorsal root entry zone (DREZ) lesions were made in the cervical dorsal horn in cat and monkey. Terminal degeneration was observed in the lateral cervical nucleus in cat and contralateral VPL in monkey by Fink-Heimer stain. WGA-HRP was injected in the cervical dorsal horn of cat and retrograde labelled cells were observed mainly in the raphe nucleus, parabrachial nucleus, locus coeruleus, K?lliker-Fuse nucleus, Eddinger-Westphal nucleus, and hypothalamic area, indicating that these descending fiber systems are involved by the DREZ lesion. The functional role of these fibers in regard to deafferentation pain relief seems now to be open to discussion.     

Lesions of spinal and trigeminal dorsal root entry zone for deafferentation pain. Experience of 35 cases

Spinal and trigeminal dorsal root entry zone destruction (DREZ-tomy) was performed on 35 patients with deafferentation pain of various types. Overall, satisfactory pain relief was obtained in 65.5% of spinal DREZ-tomy cases in the follow-up observation. The result in the brachial plexus avulsion group was the best (82.4% improved), followed by the limb pain group without root avulsion (50.0%), but the truncal or visceral pain group showed the worst result (33.3%). Two patients with postherpetic trigeminal neuralgia were completely relieved of pain in the average follow-up period of 32 months, while in 2 patients with postrhizotomy facial pain, pain recurred 4 months after the operation in 1, and, in the other, pain in the medial part of the face remained unchanged. Complications were seen in about 60% of the patients, which were, however, all mild, except for 2 cases of death due to gastrointestinal disease.     

Involuntary movements of the lower extremity following dorsal root entry zone lesions in a man treated for phantom limb pain

A patient developed continuous patterned involuntary movements of abduction-adduction, flexion-extension of his right lower extremity following surgical placement of spinal dorsal root entry zone lesions for the treatment of phantom limb pain. The stereotype movements were monitored by video and electromyographic recording of quadriceps femoris and hamstring muscles. Administration of para-chlorophenylbutyric acid (baclofen) dramatically stopped the involuntary movements and electromyographic silence ensued. Voluntary muscle movements were preserved. The theoretical implications of this unique movement disorder and central patterning of motor activity within the spinal cord are discussed.     

Results of treatment of trigeminal neuralgia by microvascular decompression of the Vth nerve at its root entry zone.

Eighty five patients suffering from trigeminal neuralgia resistant to medical therapy underwent surgical treatment for relief of pain at the Department of Neurosurgery University Alexander Hospital Sofia from 1981 until 1997. Microvascular decompression at the root entry zone of the V(th) nerve has been performed using the technique of Jannetta. The operative exploration of the parapontine root entry zone disclosed neurovascular conflicts in 87.1% of the cases. They represented displacement and/or distortion, sometimes pressure grooves, discoloration, altered vascularity of the V(th) nerve. The analysis of early postoperative results have shown an excellent outcome in 90.6% of the cases, good in 3.5% and poor in 2.4% with mortality of 3.5% early in these series when no postoperative monitoring was available. The follow up study one year after surgery revealed 90.2% excellent and 3.7% good results and poor outcome and recurrences in 6.1% of the cases. Patients with long lasting trigeminal neuralgia, previous destructive procedures, venous compression, lack of convincible evidences for neurovascular conflicts had less favorable outcome or recurrences. In the last years partial sensory rhizotomy was performed in cases when no neurovascular conflicts were found out. Patients with unquestionable arterial compression leading to displacement associated with distortion and pressure grooves had excellent outcomes. Early recurrences were associated with missed pathology at the entry zones. During reexplorations for late recurrences new arterial compression was found in less than half of the cases.     

Photosynthesis and root growth in Spartina alterniflora in relation to root zone aeration

Spartina alterniflora Lois. is a dominant species growing in intermediate and saline marshes of the US Gulf coast and Atlantic coastal marshes. S. alterniflora plants were subjected to a range of soil redox potential (Eh) conditions representing a well aerated to reduced conditions in a rhizotron system under controlled environmental conditions. The low soil Eh resulted in inhibition of root elongation shortly after treatment initiation. Root elongation was reduced as soil Eh approached values below ca. +350 mV. Substantial decrease in root elongation was noted when soil Eh fell below +200 mV. Generally, net photosynthetic rate (PN) decreased as soil Eh was reduced, with substantial reductions in PN found when Eh approached negative values. Average PN was reduced to 87, 64, and 44% of control under +340, +245, and -180 mV treatments, respectively. The reductions in root elongation and PN in response to low soil Eh indicated the adverse effects of low soil Eh on plant functioning and the need for periods of soil aeration that allow plants to resume normal functioning. Thus periods of drainage allowing soil aeration during the growing season appear to be critical to S. alterniflora by providing favorable conditions for root growth and gas exchange with important implications for plant carbon fixation. This revised version was published online in June 2006 with corrections to the Cover Date.     

Photosynthesis and root growth in Spartina alterniflora in relation to root zone aeration

Spartina alterniflora Lois. is a dominant species growing in intermediate and saline marshes of the US Gulf coast and Atlantic coastal marshes. S. alterniflora plants were subjected to a range of soil redox potential (Eh) conditions representing a well aerated to reduced conditions in a rhizotron system under controlled environmental conditions. The low soil Eh resulted in inhibition of root elongation shortly after treatment initiation. Root elongation was reduced as soil Eh approached values below ca. +350 mV. Substantial decrease in root elongation was noted when soil Eh fell below +200 mV. Generally, net photosynthetic rate (PN) decreased as soil Eh was reduced, with substantial reductions in PN found when Eh approached negative values. Average PN was reduced to 87, 64, and 44% of control under +340, +245, and -180 mV treatments, respectively. The reductions in root elongation and PN in response to low soil Eh indicated the adverse effects of low soil Eh on plant functioning and the need for periods of soil aeration that allow plants to resume normal functioning. Thus periods of drainage allowing soil aeration during the growing season appear to be critical to S. alterniflora by providing favorable conditions for root growth and gas exchange with important implications for plant carbon fixation.     

根际低氧胁迫对网纹甜瓜果期根系氮代谢的影响

采用气雾法栽培系统,研究了根际低氧(10%和5% O2)胁迫对网纹甜瓜(Cucumis melo)果实发育期间根系氮代谢的影响。结果表明:在30 d试验期内,与对照(21% O2)相比,低氧胁迫网纹甜瓜根系硝态氮(NO3--N)含量、铵态氮(NH4+-N)含量、硝酸还原酶(NR)活性、谷氨酰氨合成酶(GS)活性先增后降;在低氧处理20 d时,网纹甜瓜上述指标显著高于对照,低氧处理30 d时,显著低于对照,且5% O2处理变化的幅度大于10% O2处理;谷氨酸脱氢酶(GDH)活性在低氧处理10 d时显著低于对照,处理20 d时,与对照差异不显著;谷草转氨酶(GOT)活性在低氧处理20 d时与对照差异不显著,处理30 d时,显著低于对照;在5% O2处理期间谷丙转氨酶(GPT)活性显著低于对照,10% O2处理20 d时显著低于对照;在低氧处理期间,根系中可溶性蛋白质含量、根系伤流液中氨基酸的总量和大部分氨基酸的含量均随着根际O2浓度的降低而减少;网纹甜瓜果实发育期间根际O2浓度长期处于10% O2以下时,根系对氮的吸收、代谢能力下降,植株氮循环水平降低。     

Non-invasive estimation of root zone soil moisture from coarse root reflections in ground-penetrating radar images

Plant and Soil - Root zone soil moisture is an important component in water cycling through the soil-plant-atmosphere continuum. However, its measurement in the field remains a challenge,...