A modified (“cold”) technique of Sindou’s dorsal root entry zone-otomy for spasticity of the lower limbs

Background: Surgery in the dorsal root entry zone (DREZ) was introduced in 1972 to treat pain and spasticity. Originally, Sindou's technique involved performing the DREZ surgical lesion utilizing a scalpel and bipolar cautery. Here, we introduce a variation of the original technique, avoiding cautery for 14 consecutive patients (Group 2), and compared them with a previous series of 22 patients, operated on with the original Sindou's technique (Group 1). Methods: We performed the modified DREZ technique in 14 consecutive patients with lower limb spasticity. After sharply opening the lateral sulcus (i.e., lateral to the dorsal root), we interspersed fragments of absorbable gelatin sponge to prevent heat from cautery spreading to the surrounding neural tissues. Results: group, after "cold MDT," no patients, 0 of 14 total patients, were worse. Further, spasticity improved in approximately 82% of patients from both groups. Conclusion: In this short series of 14 patients (Group 2), we observed benefits similar to those described for patients undergoing classical DREZ lesions utilizing Sindou's technique (Group 1), but none sustained any new postoperative motor deficits.