Dorsal root entry zone lesioning for brachial plexus avulsion pain: a case series

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.