Dorsal root entry zone lesioning used to treat central neuropathic pain in patients with traumatic spinal cord injury: a systematic review.
METHODS
A systematic review was conducted for studies of any design.


OBJECTIVE
To evaluate the effectiveness and safety of dorsal root entry zone lesioning in treating central neuropathic pain of patients with traumatic spinal cord injury.


BACKGROUND
Central neuropathic pain has a great impact on the quality of life of many patients with traumatic spinal cord injury. Dorsal root entry zone lesioning has become one of several treatment options. No previous systematic reviews were found that address this indication for the procedure.


METHODS
Several computerized databases were searched along with reference lists of eligible articles and personal files of advisory panel members. Only primary studies of patients older than 13 years with both traumatic spinal cord injury and central neuropathic pain receiving dorsal root entry zone lesioning were included. Two assessors independently performed data extraction and quality assessment for all the studies.


RESULTS
The selection criteria were met by 11 studies. All were case series of 5 to 54 patients. As reported by 10 of the studies, at least 50% of the patients attained more than 50% pain relief or experienced no pain limitation of activity and no need for narcotics. However, all the studies had poorly defined eligibility criteria or none at all, no control groups, and inadequate reporting of adverse effects. Only one study provided adequate patient description. None of the studies reported the validity, reliability, or responsiveness of outcome measures.


CONCLUSIONS
Reviewed studies indicate promising results from dorsal root entry zone lesioning for the treatment of central neuropathic pain in selected patients with traumatic spinal cord injury. However, the strength of the evidence provided by the studies was poor in terms of study design, outcome measures, reports on the severity of adverse effects, patient selection criteria, and patient description. For these reasons, the evidence is weak for the use of dorsal root entry zone lesioning to relieve central neuropathic pain in patients with traumatic spinal cord injury.
Denkers
Matthew R
MR
Undergraduate Medical Programme, McMaster University, Hamilton, Ontario, Canada.
Biagi
Heather L
HL
Ann O'Brien
Mary
M
Jadad
Alejandro R
AR
Gauld
Mary E
ME
D000328:Adult; D017115:Catheter Ablation / Q000009:adverse effects; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000601:surgery*; D016896:Treatment Outcome