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.

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.

scholarly journals Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion Injuries: Case Series and Literature Review

2021 ◽  
Vol 2 ◽  
Author(s):  
Alan Chalil ◽  
Qian Wang ◽  
Mohamad Abbass ◽  
Brendan G. Santyr ◽  
Keith W. MacDougall ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Pain Intensity ◽  
Dorsal Root ◽  
Case Series ◽  
Permanent Disability ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Brachial Plexus Avulsion ◽  
Deafferentation Pain ◽  
Root Entry Zone

Introduction: Brachial plexus avulsion (BPA) injuries commonly occur secondary to motor vehicle collisions, usually in the young adult population. These injuries are associated with significant morbidity, and up to 90% of patients suffer from deafferentation pain. Neuromodulation procedures can be efficacious in the treatment of refractory neuropathic pain, although the treatment of pain due to BPA can be challenging. Dorsal root entry zone (DREZ) lesioning is a classical and effective neurosurgical technique which has become underutilized in treating refractory root avulsion pain.Methods: A systematic review of the different technical nuances, procedural efficacy, and complication profiles regarding DREZ lesioning for BPA injuries in the literature is included. We also present an institutional case series of 7 patients with BPA injuries who underwent DREZ lesioning.Results: In the literature, 692 patients were identified to have undergone DREZ lesioning for pain related to BPA. In 567 patients, the surgery was successful in reducing pain intensity by over 50% in comparison to baseline (81.9%). Complications included transient motor deficits (11%) and transient sensory deficits (11%). Other complications including permanent disability, cardiovascular complications, infections, or death were rare (<1.9%). In our case series, all but one patient achieved >50% reduction in pain intensity, with the mean pre-operative pain of 7.9 ± 0.63 (visual analog scale) reduced to 2.1 ± 0.99 at last follow-up (p < 0.01).Conclusion: Both the literature and the current case series demonstrate excellent pain severity reduction following DREZ ablation for deafferentation pain secondary to BPA.

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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