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01-12-2017 | Original Article - Functional

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

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

Published in: Acta Neurochirurgica | Issue 12/2017

Abstract

Background

Chronic pain is a disabling condition that adversely affects patient quality of life. The dorsal root entry zone lesioning procedure (DREZotomy) is a modality used to treat intractable pain caused by insults to neural structures. This study aimed to investigate the efficacy of and the factors that determine the outcome of microsurgical DREZotomy (MDT).

Method

All consecutive patients who underwent MDT for treatment of intractable pain during September 2008 to December 2016 were enrolled. Demographic data, clinical characteristics, intraoperative findings, and postoperative outcomes were analyzed.

Results

The 40 included patients underwent MDT for relief of intractable pain caused by 27 brachial plexus injuries (BPIs), 6 spinal cord injuries, 3 neoplasms, and 4 other causes. A significant reduction in pain was observed post-MDT for both average (p < 0.001) and maximal pain (p < 0.001). Favorable outcome (≥50% pain reduction) was observed in 67.5% of patients, with the best outcome in BPI-related pain. In multivariate analysis, injury of the spinal nerve root (root avulsion or injury) was significantly associated with good average pain relief (OR, 5.8; 95% CI, 1.2–27.5; p = 0.026) and pain freedom (OR, 5.0; 95% CI, 1.12–22.30; p = 0.035). Electrical pain (OR, 6.49; 95% CI, 1.20–35.19; p = 0.030) and lower number of painful dermatomes (OR, 1.30; 95% CI, 1.01–1.67; p = 0.039) were significantly associated with good maximal pain relief.

Conclusions

MDT is an effective procedure for treatment of intractable pain in well-selected patients, particularly in cases with brachial plexus avulsion pain. Injury of the spinal nerve root (brachial plexus avulsion and cauda equina injury) was associated with good average pain relief and pain freedom, and electrical pain and lower number of painful dermatomes were associated with good maximal pain relief. The results are useful in the selection of candidates for DREZotomy and prediction of surgical outcome.

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Title: Efficacy and factors determining the outcome of dorsal root entry zone lesioning procedure (DREZotomy) in the treatment of intractable pain syndrome
Authors: Nontaphon Piyawattanametha
Bunpot Sitthinamsuwan
Pramote Euasobhon
Nantthasorn Zinboonyahgoon
Pranee Rushatamukayanunt
Sarun Nunta-aree
Publication date: 01-12-2017
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 12/2017
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-017-3345-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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