Abstract: Objective To investigate the efficacy and safety of multimodal neuroelectrophysiological monitoring in the treatment of pain after spinal cord injury by incision of the dorsal root of the spinal cord into the medullary region.Methods Four patients with pain after spinal cord injury were treated with Dorsal Root Entry Zone (DREZ) incision under multimodal neuroelectrophysiological monitoring,including 2 cases of brachial plexus avulsion,1 case of thoracic spine injury,and 1 case of lumbar spine injury.All patients were monitored for lower limb movement and sensation through sensory evoked potentials (SEP) and motor evoked potentials (MEP).When the latency of SEP and MEP decreases by 10% on the healthy side or the amplitude decreases by 30% on the baseline,a warning is given to guide the incision angle and deep range of DREZ.All patients were analyzed for preoperative and postoperative pain visual analysis scale (VAS),muscle strength and deep sensory function of healthy limbs on the surgical side,and second bowel function.At the same time,the quality of life of patients before and after surgery was evaluated using the SF-36 quality of life scale.Results After a follow-up of 9 months to 3 years,the pain relief rate in 3 patients was 100%,and the pain relief rate in 1 patient was greater than 50%.None of the patients had muscle decline and deep sensory decline in the healthy limb on the surgical side,and there was no decline in the second bowel function in all patients.The total score of SF-36 increased from 80.6±10.2 before surgery to 108.9±12.4 (P<0.05).Conclusion Multimodal neuroelectrophysiological monitoring of spinal dorsal root incision can not only effectively alleviate pain,improve quality of life,but also effectively protect spinal cord function.

Key words: Pain after spinal cord injury, Incision of the spinal dorsal root into the medullary region, Multimodal, Neuroelectrophysiology

摘要： 目的 探讨多模态神经电生理监测下脊髓背根入髓区切开术对脊髓损伤后疼痛的疗效和安全性。方法 多模态神经电生理监测下对4例脊髓损伤后疼痛患者行脊髓背根入髓区(Dorasl Root Entry Zone,DREZ)切开术,其中臂丛神经撕脱2例、胸椎和腰椎脊髓损伤各1例。所有患者通过体感诱发电位(SensoryEvoked Potentials,SEP)和运动诱发电位(Motor Evoked Potentials,MEP)对患者下肢运动和感觉进行监测。当SEP和MEP潜伏期下降于健侧10%或波幅下降于基线30%进行预警,指导DREZ切开角度和深部范围。分析术前和术后疼痛视觉模拟评分(visual analysis scale,VAS)、术侧健康肢体肌力和深感觉功能以及二便功能,采用SF-36生活质量评分量表评价患者手术前后生活质量。结果 术后随访9个月~3年,3例患者疼痛缓解率为100%,1例患者疼痛缓解大于50%,无一例患者出现术侧健康肢体肌力下降和深感觉减退,所有患者二便功能无下降,SF-36总评分由术前80.6±10.2上升为108.9±12.4(P<0.05)。结论 多模态神经电生理监测下脊髓背根入髓区切开术不仅能有效缓解疼痛、改善生活质量,还能有效保护脊髓功能。

关键词: 脊髓损伤后疼痛, 脊髓背根入髓区切开, 多模态, 神经电生理