DORSAL ROOT ENTRY ZONE RHIZOTOMY (DREZotomy)

• Dorsal Root Entry Zone Rhizotomy is useful for the patients with paraplegia and severe pain.
• In this surgical procedure, lesioning is done at the level of the dorsal horn of the spinal cord where the sensory nerve roots enter. This lesioning alters the spinal reflex arc and thus relieves the spasticity.
• Following this surgical procedure any chances of returning of motor functions are lost. Therefore, this procedure is advised to those patients who have no chance of improvement in their motor functions.
• This procedure is only performed one time and the relief from the spasticity is life-long. This is the biggest advantageous point of this procedure.
• The surgical procedure does not only help in relieving the spasticity but also helps in alleviating the pain.
• For relief from severe spastic paraplegia, it is advised to resect minimum five roots with sparing of the fourth lumbar root intact, because this spared root usually guarantees about the extensor reflex of the knee which is important for standing and walking. However, during procedure intraoperative neurophysiological monitoring is used to know that by stimulation of which lumbar roots the extension reflex of the knee is affected.
• Thus, the common practice is to resect the second, third and fifth lumbar roots along with first and second sacral roots.
• To decrease the chances of sensory deformity, it is advised to preserve at least one rootlet out of five (on average) for each root, from L1 to S1.