Introduction: Chronic neuropathic pain in traumatic paraplegia appears as the illness by itself, and it represents the unique treatment challenge. The dorsal horn, as anatomical structure involved in pain generating, has been recognized as a target for ablative DREZ surgery. The dorsal horn suction technique as the DREZ lesioning method takes advantage of the natural difference in dynamical viscosity of the cord white versus gray matter to perform DREZ lesions by using the suction of the dorsal horn gray matter.
Methods: The testing of the mechanical properties of the cord tissue were studied in the cadaveric specimens. In the period April 1997 - December 2015, 24 patients, 21 males and 3 females, with a mean age of 41 years (range, 24-69) were operated on using dorsal horn suction as the DREZ lesioning. NMR examination was done preoperatively to determine the morphology and position of the dorsal horn.
Results: The white cord substance had four-time higher dynamical viscosity in comparison with the dorsal horn gray substance (150 Pascal/second versus 37.5). Dorsal horn was most voluminous and just under the cord surface at the lumbar enlargement while it was tiny, on the distance from the cord surface at the thoracic cord segments.
Conclusions: The lumbar enlargement, with most voluminous dorsal horn mass positioned just under the cord surface provides best anatomical condition for controllable and selective suctioning of the gray mass, while the thoracic cord with tiny and distant dorsal horn imposes technical difficulties for the procedure. The correlation between dorsal horn morphology, the feasibility of the suctioning technique, pain pattern, intensity and the outcome of surgery are discussed.
Patient Care: Understanding of the pain mechanism, surgical technique, will help for the proper selection of the patient for the DREZ surgery and avoidance of the complications of the surgery
Learning Objectives: Understanding of the mechanism of the neuropathic pain of spinal cord injurz origin, dorsal horn functional anatomy, pain treatment options, dorsal horn suctioning DREZ lesioning technique