Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion Pain: a Case Series

Overview

Journal Spinal Cord Ser Cases

Specialty Neurology

Date 2023 Mar 9

PMID 36894525

Authors

Axumawi Gebreyohanes

Aminul Islam Ahmed

David Choi

Affiliations

Soon will be listed here.

Abstract

Study Design: Retrospective case series.

Objectives: Dorsal root entry zone (DREZ) lesioning can be performed in patients with intractable pain following brachial plexus avulsion (BPA). However, post-operative outcomes are variable and it is uncommonly used. We sought to determine the pain outcomes and complication profile of DREZ lesioning for BPA.

Setting: Quaternary neurosurgical centre.

Methods: All patients that had undergone DREZ lesioning for BPA pain over a 13-year period were included. Patients were assessed for outcome with regard to degree of pain relief and presence of complications.

Results: Fourteen patients were reviewed, with a median post-operative follow-up duration of 27 months (1-145 months). Of these, ten were contactable for long-term telephone review, with a median post-operative duration of 37 months (11-145 months). At earliest review post-operatively, 12 of 14 patients (86%) had some level of pain relief: complete pain relief in four patients (29%) and partial pain relief in eight patients (57%). At most recent post-operative review, ten of 14 patients (71%) reported lasting significant pain relief: four (29%) had complete pain relief, six (43%) had partial pain relief and four (29%) had insignificant pain relief. Complications were predominantly sensory, including ataxia, hypoaesthesia and dysaesthesia. Four patients (29%) reported persistent motor complications at final follow-up.

Conclusions: DREZ lesioning is uncommonly performed. It remains a reasonable option for relief of refractory BPA pain in selected cases, though there is a significant complication rate. Future prospective studies may enable quantification of pre- and post-lesioning analgesic use, another important determinant of procedure success.

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