Long-term follow up of dorsal root entry zone lesions in brachial plexus avulsion.

Abstract OBJECTIVE Significant numbers of patients experience intractable pain after brachial plexus root avulsions. Medications and surgical procedures such as amputation of the limb are often not successful in pain treatment. METHODS Forty-seven patients with intractable pain after traumatic cervical root avulsions were treated with dorsal root entry zone coagulation between 1980 and 1998. The dorsal root entry zone coagulation procedure was performed 4 months to 12 years after the trauma, and patients were monitored for up to 18 years (average follow-up period, 14 yr). RESULTS Immediately after surgery, 75% of patients experienced significant pain reduction; this value was reduced to 63% during long-term follow-up monitoring. Nine patients experienced major complications, including subdural hematomas (n = 2) and motor weakness of the lower limb (n = 7). Improved coagulation electrodes with thermistors that could produce smaller and more-accurate lesion sizes, which were introduced in 1989, significantly reduced the number of complications. CONCLUSION Central deafferentation pain that persists and becomes intractable among patients with traumatic cervical root avulsions has been difficult to treat in the past. Long-term follow-up monitoring of patients who underwent the dorsal root entry zone coagulation procedure in the cervical cord indicated that long-lasting satisfactory relief is possible for the majority of individuals, with acceptable morbidity rates.

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Follow-up 26 years after dorsal root entry zone thermocoagulation for brachial plexus avulsion and phantom limb pain

Journal of Neurosurgery ◽

10.3171/2010.5.jns091520 ◽

2011 ◽

Vol 114 (1) ◽

pp. 196-199 ◽

Cited By ~ 6

Author(s):

Nestor D. Tomycz ◽

John J. Moossy

Keyword(s):

Brachial Plexus ◽

Upper Extremity ◽

Pain Control ◽

Dorsal Root ◽

Phantom Limb ◽

Entry Zone ◽

Dorsal Root Entry Zone ◽

Brachial Plexus Avulsion ◽

Root Entry Zone

Brachial plexus avulsion and limb amputation are often associated with intractable chronic pain. Dorsal root entry zone (DREZ) thermocoagulation is an effective surgical treatment for upper-extremity deafferentation pain. The authors describe the clinical follow-up and imaging in a patient who underwent DREZ thermocoagulation 26 years ago for postamputation phantom limb syndrome with associated brachial plexus avulsion. This patient continues to have successful pain control without phantom limb sensation and has never experienced a recurrence of his left upper-extremity pain syndrome. This report lends credibility to the notion that, among ablative neurosurgical pain operations, DREZ thermocoagulation may provide the greatest durability of pain control.

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Dorsal Root Entry Zone Lesions for the Treatment of Brachial Plexus Avulsion Injuries: A Follow-up Study

Neurosurgery ◽

10.1227/00006123-198802000-00016 ◽

1988 ◽

Vol 22 (2) ◽

pp. 369-373 ◽

Cited By ~ 53

Author(s):

Allan H. Friedman ◽

Blaine S. Nashold ◽

Peter R. Bronec

Keyword(s):

Pain Relief ◽

Brachial Plexus ◽

Dorsal Root ◽

Entry Zone ◽

Dorsal Root Entry Zone ◽

Avulsion Injury ◽

Brachial Plexus Avulsion ◽

Root Entry Zone ◽

Good Pain Relief

Abstract Dorsal root entry zone (DREZ) lesions have been shown to yield short term relief from the pain associated with a brachial plexus avulsion injury. Because of the propensity of pain to recur after neuroablative procedures, 39 patients with pain after a brachial plexus avulsion injury were observed for 14 months to 10 years after DREZ lesions were made. Fifty-four per cent of these patients were afforded good pain relief. Of 21 patients who had multiple small lesions made within the DREZ, 15 (72%) were afforded good pain relief. (Neurosurgery 22:369-373, 1988)

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Correlation of preoperative MRI with the long-term outcomes of dorsal root entry zone lesioning for brachial plexus avulsion pain

Journal of Neurosurgery ◽

10.3171/2015.2.jns142572 ◽

2016 ◽

Vol 124 (5) ◽

pp. 1470-1478 ◽

Cited By ~ 4

Author(s):

Andrew L. Ko ◽

Alp Ozpinar ◽

Jeffrey S. Raskin ◽

Stephen T. Magill ◽

Ahmed M. Raslan ◽

...

Keyword(s):

Pain Relief ◽

Brachial Plexus ◽

Dorsal Horn ◽

Dorsal Root ◽

Entry Zone ◽

Dorsal Root Entry Zone ◽

Root Entry Zone ◽

Pain Outcomes

OBJECT Lesioning of the dorsal root entry zone (DREZotomy) is an effective treatment for brachial plexus avulsion (BPA) pain. The role of preoperative assessment with MRI has been shown to be unreliable for determining affected levels; however, it may have a role in predicting pain outcomes. Here, DREZotomy outcomes are reviewed and preoperative MRI is examined as a possible prognostic factor. METHODS A retrospective review was performed of an institutional database of patients who had undergone brachial plexus DREZ procedures since 1995. Preoperative MRI was examined to assess damage to the DREZ or dorsal horn, as evidenced by avulsion of the DREZ or T2 hyperintensity within the spinal cord. Phone interviews were conducted to assess the long-term pain outcomes. RESULTS Between 1995 and 2012, 27 patients were found to have undergone cervical DREZ procedures for BPA. Of these, 15 had preoperative MR images of the cervical spine available for review. The outcomes were graded from 1 to 4 as poor (no significant relief), good (more than 50% pain relief), excellent (more than 75% pain relief), or pain free, respectively. Overall, DREZotomy was found to be a safe, efficacious, and durable procedure for relief of pain due to BPA. The initial success rate was 73%, which declined to 66% at a median follow-up time of 62.5 months. Damage to the DREZ or dorsal horn was significantly correlated with poorer outcomes (p = 0.02). The average outcomes in patients without MRI evidence of DREZ or dorsal horn damage was significantly higher than in patients with such damage (3.67 vs 1.75, t-test; p = 0.001). A longer duration of pain prior to operation was also a significant predictor of treatment success (p = 0.004). CONCLUSIONS Overall, the DREZotomy procedure has a 66% chance of achieving meaningful pain relief on long-term follow-up. Successful pain relief is associated with the lack of damage to the DREZ and dorsal horn on preoperative MRI.

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Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion: A Comprehensive Literature Review

Operative Neurosurgery ◽

10.1093/ons/opaa447 ◽

2021 ◽

Author(s):

Axumawi Mike Hailu Gebreyohanes ◽

Aminul Islam Ahmed ◽

David Choi

Keyword(s):

Brachial Plexus ◽

Patient Outcomes ◽

Dorsal Root ◽

Cervical Spinal Cord ◽

Entry Zone ◽

Neurosurgical Procedure ◽

Dorsal Root Entry Zone ◽

Brachial Plexus Avulsion ◽

Root Entry Zone ◽

Comprehensive Literature Review

Abstract Dorsal root entry zone (DREZ) lesioning is a neurosurgical procedure that aims to relieve severe neuropathic pain in patients with brachial plexus avulsion by selectively destroying nociceptive neural structures in the posterior cervical spinal cord. Since the introduction of the procedure over 4 decades ago, the DREZ lesioning technique has undergone numerous modifications, with a variety of center- and surgeon-dependent technical differences and patient outcomes. We have reviewed the literature to discuss reported methods of DREZ lesioning and outcomes.

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Dorsal root entry zone lesions to control central pain in paraplegics

Journal of Neurosurgery ◽

10.3171/jns.1981.55.3.0414 ◽

1981 ◽

Vol 55 (3) ◽

pp. 414-419 ◽

Cited By ~ 74

Author(s):

Blaine S. Nashold ◽

Elizabeth Bullitt

Keyword(s):

Dorsal Root ◽

Central Pain ◽

Entry Zone ◽

Dorsal Root Entry Zone ◽

Content Type ◽

Root Entry Zone ◽

Cord Injury ◽

Fine Print

✓ Thirteen patients with intractable long-term pain following spinal cord injury and paraplegia were treated with dorsal root entry zone lesions placed at the level just above the transection. Pain relief of 50% or more was achieved in 11 of the 13 patients, with follow-up periods ranging from 5 to 38 months. A previous report showed that central pain from brachial plexus avulsion could be relieved by dorsal root entry zone lesions, and this technique has been extended to the central pain phenomena associated with spinal trauma and paraplegia.

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