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. 2024 May 30;166(1):241.
doi: 10.1007/s00701-024-06132-9.

Dorsal root entry zone lesioning for brachial plexus avulsion - technical evolution and long-term follow-up

Vishwas Vijayendra  1 , Deepti Bhargava  2 , Michael Pridgeon  3 , Rafal Szylak  2 , Paul Eldridge  4 , Jibril Osman-Farah  2
Affiliations

Dorsal root entry zone lesioning for brachial plexus avulsion - technical evolution and long-term follow-up

Vishwas Vijayendra et al. Acta Neurochir (Wien). .

Abstract

Background: Brachial plexus avulsion (BPA) injuries can cause severe deafferentation pain. This has been successfully treated with dorsal root entry zone (DREZ) lesioning. Distortions in anatomy following a BPA injury can make identifying neural structures challenging. We describe a modification to the operative technique that improves the surgical view and the advanced intraoperative neuromonitoring (IONM) employed to identify DREZ. We have analysed the long-term outcomes for pain, quality of life, and complications in patients undergoing DREZ lesioning.

Methods: This is a single-centre retrospective case series including patients who underwent DREZ lesioning with IONM for brachial plexus avulsion between 2012 and 2022. Analysed data included pre- and postoperative pain (VAS), quality of life score for chronic pain, and complications. The evolution of the surgical approach is discussed.

Results: 44 consecutive patients underwent a DREZ lesioning procedure with intraoperative monitoring and mapping. In these patients the mean VAS score improved from 8.9 (7-10) to 1.87 (0-6) (p < 0.0001) at the time of discharge. 31 patients were followed-up for more than 12 months with a mean duration of follow-up of 41 months and their results were as follows: the mean VAS improved from 9.0 (7-10) to 4.1 (0-9) (p < 0.0001) at the last follow-up and the mean QOL values improved from 3.7 (2-6) to 7.4 (4-10) (p < 0.0001). The long-term outcomes were 'good' in 39%, 'fair' in 29% and 'poor' in 32% of patients. 55% of the patients were able to stop or reduce pain medications.

Conclusions: Modifications of surgical technique provide better exposure of DREZ, and IONM aids in identifying DREZ in the presence of severe intra-dural changes. Long-term outcomes of DREZ lesioning indicate not only a reduction in pain but also a significant improvement in quality of life.

Keywords: Brachial plexus avulsion; DREZ; Deafferentation pain; IONM.

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