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

2011 ◽  
Vol 114 (1) ◽  
pp. 196-199 ◽  
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.

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

Neurosurgery ◽  
1988 ◽  
Vol 22 (2) ◽  
pp. 369-373 ◽  
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)

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

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.

Treatment of Refractory Pain after Brachial Plexus Avulsion with Dorsal Root Entry Zone Lesions

Neurosurgery ◽  
2001 ◽  
Vol 48 (6) ◽  
pp. 1269-1277 ◽  
Author(s):  
Madjid Samii ◽  
Steffani Bear-Henney ◽  
Wolf Lüdemann ◽  
Marcos Tatagiba ◽  
Ulrike Blömer
Keyword(s):  
Brachial Plexus ◽  
Dorsal Root ◽  
Intractable Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
Long Term Follow Up ◽  
Cervical Root

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.

Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion Pain

2019 ◽  
pp. 71-78
Author(s):  
Daniel R. Cleary ◽  
Sharona Ben-Haim
Keyword(s):  
Brachial Plexus ◽  
Dorsal Horn ◽  
Dorsal Root ◽  
High Speed ◽  
Csf Leak ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Brachial Plexus Avulsion ◽  
Root Entry Zone ◽  
Dorsal Columns

Brachial plexus avulsion is often seen after motorcycle accidents or with high-speed ejection injuries. Rehabilitation focuses on regaining motor and sensory function, but the detrimental effect of pain is often underappreciated. Up to 90% of patients with avulsion injury will experience deafferentation pain, which until relatively recently has been difficult to treat medically or surgically. DREZotomy, the ablation of neurons in the dorsal root entry zone of the spinal cord, was introduced in the 1970s and has since changed how we treat brachial plexus avulsion and other forms of neuropathic pain. The procedure is straightforward: with a standard cervical approach, a hemilamiotomy is used to expose the area of interest. The dura is opened, and areas of root avulsion are identified. Using bipolar cautery, RF ablation, or ultrasound, the 2nd order neurons in dorsal horn are destroyed for the affected dermatomes. Complications include standard cervical spinal approach-related issues, such as infection, hematoma, CSF leak, and kyphosis. Risks specific to the procedure include post-operative motor or sensory deficits, due to the proximity of the corticospinal tracts and the dorsal columns to dorsal horn. As many as 18% of patients report a long-term neurological deficit post-operatively, but despite these complications, 80% of patients say they would repeat the procedure. Multiple outcomes series have been published since the procedure was introduced, and typically 70–80% of patients receive benefit from the procedure.

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