Dorsal Root Entry Zone Lesions for the Treatment of Post-Brachial Plexus Avulsion Injury Pain

Abstract

The pain which occurs concomitant to a brachial plexus avulsion injury has proven to be recalcitrant to most conventional forms of therapy. In 1976, Nashold et al. proposed destruction of the substantia gelatinosa as possible therapy for this type of pain [6]. It soon became obvious that in practice these surgical lesions destroy not only the substantia gelatinosa but also the dorsal horn, Lissauer’s tract, and the adjacent portion of the posterior and lateral funiculi, and thus were termed dorsal root entry zone (DREZ) lesions. Early reports of this form of therapy with short follow-up periods were encouraging [5], but we know from our experience with other neuroablative procedures such as percutaneous cordotomy and trigeminal rhizotomy that immediate pain relief does not necessarily portend long-term relief of pain. In order to assess the long-term efficacy of DREZ lesions, we undertook this retrospective analysis of 56 patients who had undergone DREZ lesions for the treatment of intractable pain secondary to a brachial plexus avulsion.