Efficacy and factors determining the outcome of dorsal root entry zone lesioning procedure (DREZotomy) in the treatment of intractable pain syndrome

Piyawattanametha, Nontaphon; Sitthinamsuwan, Bunpot; Euasobhon, Pramote; Zinboonyahgoon, Nantthasorn; Rushatamukayanunt, Pranee; Nunta-aree, Sarun

doi:10.1007/s00701-017-3345-3

Cited by 16 publications

(16 citation statements)

References 56 publications

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“…30 Surgical ablation of the DREZ destroys and thereby nullifies aberrant nociceptive processing that gives rise to BPA pain. Since its origins in the 1970s, 15,31 DREZ lesioning has been attempted for relief of an aetiologically diverse collection of pain syndromes: spinal cord injury [32][33][34] ; cauda equina injury 32,[35][36][37] ; conus medullaris or lumbosacral plexus injury 30,36,38,39 ; phantom limb pain 32,33,40,41 ; post-herpetic neuralgia 33,[40][41][42] ; syringomyelia 41 ; complex regional pain syndrome 32,33 ; cancer-or radiation-induced pain 32,34,40 ; and spasticity 2,40 . Nowadays, although DREZ lesioning is occasionally used for these alternative pathologies, its primary indication is for BPA deafferentation pain due to more favourable patient outcomes.…”

Section: Role Of Drez Lesioning In Bpamentioning

confidence: 99%

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

Gebreyohanes¹,

Ahmed²,

Choi³

2021

Operative Surg.

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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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Section: Role Of Drez Lesioning In Bpamentioning

confidence: 99%

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

Gebreyohanes¹,

Ahmed²,

Choi³

2021

Operative Surg.

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“…The final study list included 31 papers, all of which were case series ( 6 , 7 , 10 , 12 – 36 ) and case reports ( 37 – 39 ). No randomized controlled trials were identified.…”

Section: Resultsmentioning

confidence: 99%

“…Radiofrequency lesioning was used in 17 studies; Samii et al initially used cordotomy electrodes to perform the DREZ lesioning, but later reported switching to radiofrequency electrodes ( 12 ). Thermal coagulation using bipolar cautery was used in 8 studies ( 6 , 23 , 26 , 28 , 31 , 36 , 38 , 39 ). In one study, Sindou et al reported performing sharp incisions in the dorsolateral sulcus followed by dot coagulation using bipolar cautery ( 6 ).…”

Section: Resultsmentioning

confidence: 99%

“…Some evidence suggests that patients with longer duration of deafferentation pain (6 years or more) may experience better pain relief following DREZ ablation compared to patients with shorter duration (3 years or less) ( 6 , 26 ). Both Piyawattanametha et al and Zheng et al found that spinal root avulsion and the number of avulsed roots is associated with better pain response from DREZ ablation ( 28 , 36 ). This fits well with the pathophysiology of deafferentation pain which forms the theoretical basis of DREZ ablation; however, it is important to stress that DREZ ablation is a destructive procedure based on interruption of normal nociceptive pathways.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…0:59 Our data share similar results with other authors. [1][2][3][4][5] The dorsal DREZotomy, devised for pain due to traumatic spinal cord injury, is no longer performed because it is ineffective. The best results are obtained with the lumbar DREZ for monolateral or bilateral avulsive injury of the lower lumbar roots, namely L5 and S1.…”

Section: Transcriptmentioning

confidence: 99%

Dorsal root entry zone lesion: nuances of the technique and long-term results

Ferraresi¹,

Basso²,

Maistrello³

et al. 2020

Neurosurgical Focus: Video

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The treatment of deafferentation pain is a primary goal of a referral center for peripheral nerve surgery. DREZ is an important asset in the neurosurgeon’s armamentarium. The surgical technique and long-term results are analyzed in two series, with or without intraoperative monitoring (IOM). DREZotomy is highly effective in lumbar root avulsive injuries but is ineffective in resolving pain due to spinal cord injuries. Cervical DREZotomy for cancer pain is not superior to intrathecal morphine. In brachial plexus avulsive injuries, the largest series shows a 74% success rate, but the efficacy of the procedure is lost over time. No relevant difference has been observed since the introduction of IOM.The video can be found here: https://youtu.be/uG_kkQj5m1U

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Efficacy and factors determining the outcome of dorsal root entry zone lesioning procedure (DREZotomy) in the treatment of intractable pain syndrome

Cited by 16 publications

References 56 publications

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

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

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

Dorsal root entry zone lesion: nuances of the technique and long-term results

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