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

Gebreyohanes, Axumawi; Ahmed, Aminul I.; Choi, David

doi:10.1093/ons/opaa447

Cited by 22 publications

(20 citation statements)

References 67 publications

(222 reference statements)

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“…33 Multiple reports described substantial benefit after DREZ surgery in patients with avulsion. 18 Our patient reported 75% reduction in pain 1 year after surgery, consistent with previous reports, suggesting that DREZ should be part of the treatment algorithm for severe BP. 1,24,29 In summary, we present a case of traumatic BP who failed conservative treatments and a trial of cervical SCS but obtained significant benefit from DREZ lesioning.…”

Section: Discussionsupporting

confidence: 91%

Success with dorsal root entry zone lesioning after a failed trial of spinal cord stimulation in a patient with pain due to brachial plexus avulsion

López¹,

Sdrulla²

2021

PR9

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Pain caused by brachial plexopathy (BP) represents a challenging clinical problem with few effective therapeutic options. Here, we present a patient with severe, painful BP after a high-impact motor vehicle accident who failed conservative treatments. A trial of cervical spinal cord stimulation was completed using multiple waveforms (tonic, BurstDR, and 10 kHz) over 14 days with only 30% to 40% pain reduction. Subsequently, he underwent dorsal root entry zone lesioning with a significant decrease in his pain 1 year later. Surgical exploration revealed extensive damage and avulsion of his cervical roots that was not observed on a previous brachial plexus magnetic resonance imaging. We discuss the etiology and diagnosis of traumatic BP, possible reasons for the failed spinal cord stimulation trial, and implications for management.

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Section: Discussionsupporting

confidence: 91%

Success with dorsal root entry zone lesioning after a failed trial of spinal cord stimulation in a patient with pain due to brachial plexus avulsion

López¹,

Sdrulla²

2021

PR9

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“…In most cases, surgery is involved in treating neuropathic pain, such as dorsal root entry zone (DREZ) lesioning (or DREZotomy). DREZotomy, which PDR simulates, is an effective way to treat intractable chronic pain, including cancer pain [ 42 ], brachial plexus avulsion pain [ 43 ], etc. Our results suggest that though DREZotomy still causes pain, its painful intensity is not comparable with the chronic neuropathic pain mentioned above, as pERK1/2 and c-Fos in DRG and DH are less activated by DREZotomy.…”

Section: Discussionmentioning

confidence: 99%

Differential Activation of pERK1/2 and c-Fos Following Injury to Different Regions of Primary Sensory Neuron

Miao

Yao

Chen

et al. 2022

Life

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Nerve injury causes hyperexcitability of the dorsal root ganglion (DRG) and spinal dorsal horn (DH) neurons, which results in neuropathic pain. We have previously demonstrated that partial dorsal rhizotomy (PDR) produced less severe pain-like behavior than chronic constriction injury (CCI) or chronic compression of DRG (CCD) and did not enhance DRG neuronal excitability. However, the mechanisms underlying such discrepancy remain unclear. This study was designed to compare the activation of phosphorylated extracellular signal-regulated kinase 1/2 (pERK1/2) in DRG and DH, and c-Fos in DH following treatments of CCI, CCD, and PDR. We confirmed that thermal hyperalgesia produced by PDR was less severe than that produced by CCI or CCD. We showed that pERK1/2 in DRG and DH was greatly activated by CCI or CCD, whereas PDR produced only transient and mild pERK1/2 activation. CCI, CCD, and PDR induced robust c-Fos expression in DH; nevertheless, c-Fos+ neurons following PDR were much fewer than that following CCI or CCD. Blocking retrograde axonal transport by colchicine proximal to the CCI injury site diminished thermal hyperalgesia and inhibited pERK1/2 and c-Fos activation. These findings demonstrate that less severe pain-like behavior produced by PDR than CCI or CCD attributes to less activation of pERK1/2 and c-Fos. Such neurochemical activation partially relies on retrograde axonal transport of certain “injury signals” from the peripheral injured site to DRG somata.

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“…However, DREZ-tomy for the purpose of destroying lamina I to V and terminating the abnormal hyperactivity of the dorsal horn may result in new deafferentation pain. It has been reported that the long-term success rate was 66% as the pain gradually relapses [ 11 , 12 ]. Moreover, the effect of SCS on BPA is limited [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Cervical selective nerve root injection alleviates chronic refractory pain after brachial plexus avulsion: a case report

et al. 2022

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Background Intractable chronic pain, as well as motor, sensory, and autonomic neuropathy, significantly reduces the quality of life of brachial plexus avulsion (BPA) patients. We report the successful application of cervical selective nerve root injection (CSNRI) in a patient with BPA. Case presentation A 40-year-old man had been diagnosed with complete left BPA due to a motorcycle accident and underwent intercostal nerve transplantation at the age of 18 years and had been experiencing pain ever since. His pain increased after fracture of the left humerus, and he was referred to our pain management clinic. As his exacerbated pain was suspected to be due to peripheral nerve hypersensitivity, we performed repetitive ultrasound-guided CSNRI (3 mL of 1% mepivacaine of each) targeted C5 and 6 intervertebral foramina, and his symptoms gradually improved. Conclusions Repetitive CSNRI may help diagnose and treat BPA-associated peripheral neuropathic pain, even in patients diagnosed with BPA.

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

Cited by 22 publications

References 67 publications

Success with dorsal root entry zone lesioning after a failed trial of spinal cord stimulation in a patient with pain due to brachial plexus avulsion

Success with dorsal root entry zone lesioning after a failed trial of spinal cord stimulation in a patient with pain due to brachial plexus avulsion

Differential Activation of pERK1/2 and c-Fos Following Injury to Different Regions of Primary Sensory Neuron

Cervical selective nerve root injection alleviates chronic refractory pain after brachial plexus avulsion: a case report

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