Summary
The results of 58 dorsal root entry zone (DREZ) thermocoagulation procedures in 51 patients are reported. The postoperative analgesic effect was judged by the patients as being good (more than 75% pain reduction), fair (25–75% pain reduction) or poor (less than 25% pain reduction). Of the 14 patients who underwent surgery for pain due to cervical root avulsion, 10 (77%) had permanently good (8) or fair (2) pain relief after a mean follow up period of 76 months, another 2 (15%) experienced recurrence to the pre-operative level (initially 1 good, 1 fair) after more than 2 and 4 years, respectively. Twenty two paraplegics were operated upon, 3 of whom twice, for intractable pain. After a mean observation time of 54 months, continuing pain relief was reported by 12 (55%) patients (11 good, 1 fair), and one (initially fair) had recurrent pain after 8 months. All 3 (early) re-operations remain successful for an average period of 75 months. Poor results were seen especially in cases of associated spinal cord cysts (5 out of 7), despite combined drainage, and in patients with diffuse pain distribution (5 out of 6). Continuous marked improvement for longer periods (mean follow up: 52 months) after DREZ lesions was reported only by 2 out of 10 patients with postherpetic neuralgia (12 procedures) and by 1 out of 5 with painful states due to radiation-induced brachial plexopathy (2), previous surgery (2) and malignant tumour infiltration of the brachial plexus (1). Three patients died postoperatively due to acute cardiac failure (2) and pulmonary embolism (1). Major complications, especially permanent gait disturbances were observed in 6 patients (12%) following primary procedures and in 2 out of 7 patients after re-operations, most of them suffering from postherpetic neuralgia. Minor neurological deficits were noted in 9 cases (18%). DREZ lesions revealed to be an effective procedure in patients with pain related to root avulsion and paraplegia. In contrast, it seems to be less successful for painful states due to other plexus lesions or postherpetic neuralgia.
Similar content being viewed by others
References
Burke DC, Woodward JM (1976) Pain and phantom sensation in spinal paraplegia. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, vol 26. North-Holland, Amsterdam, pp 489–499
Dreval ON (1993) Ultrasonic DREZ-operations for treatment of pain due to brachial plexus avulsion. Acta Neurochir (Wien) 122: 76–81
Friedman AH, Bullitt E (1988) Dorsal root entry zone lesions in the treatment of pain following brachial plexus avulsion, spinal cord injury and Herpes zoster. Appl Neurophysiol 51: 164–169
Friedman AH, Nashold BS (1984) Dorsal root entry zone lesions for the treatment of postherpetic neuralgia. Neurosurgery 15: 969–970
Friedman AH, Nashold BS (1986) DREZ lesions for relief of pain related to spinal cord injury. J Neurosurg 65: 465–469
Nashold BS Jr, Urban B, Zorub DS (1975) Phantomrelief by focal destruction of substantia gelatinosa of Rolando. In: Bonica JJ, Albe-Fessard D (eds) Advances in pain research and therapy 1. Raven, New York, pp 959–963
Nashold BS Jr, Ostdahl RH (1979) Dorsal root entry zone lesions for pain relief. J Neurosurg 51: 59–69
Nashold BS Jr, Vieira J, El-Naggar AO (1990) Pain and spinal cysts in paraplegia: treatment by drainage and DREZ operation. Br J Neurosurg 4: 327–336
Rawlings III CW, El-Naggar AO, Nashold BS Jr (1989) The DREZ procedure: an update on technique. Br J Neurosurg 3: 633–642
Richter H-P, Schachenmayer W (1984) Is the substantia gelatinosa the target in dorsal root entry zone lesions? An autopsy report. Neurosurgery 15: 913–916
Richter H-P, Seitz K (1984) Dorsal root entry zone lesions for the control of deafferentation pain: experiences in ten patients. Neurosurgery 15: 956–959
Samii M, Moringlane JR (1984) Thermocoagulation of the dorsal root entry zone for the treatment of intractable pain. Neurosurgery 15: 953–955
Sairs SC, Iacono RP, Nashold BJ Jr (1985) Dorsal root entry zone lesions for post amputation pain. J Neurosurg 62: 72–76
Sindou M, Quoex C, Balleydier C (1974) Fiber organization at the posterior spinal cord-rootlet junction in man. J Comp Neurol 153: 15–26
Thomas DGT, Kitchen ND (1994) Long term follow up of dorsal root entry zone lesions in brachial plexus avulsion. J Neurol Neurosurg Psychiatry 57: 737–738
Wiegand H, Winkelmüller W (1985) Behandlung des Deafferentierungsschmerzes durch Hochfrequenzläsion der Hinterwurzeleintrittszone. DMW 110: 216–220
Young RF (1990) Clinical experience with radiofrequency and laser DREZ lesions. J Neurosurg 72: 715–720
Zeidman SM, Rossitch EJ, Nashold BJ Jr (1993) Dorsal root entry zone lesions in the treatment of pain related to radiation induced brachial plexopathy. J Spinal Disord 6: 44–47
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rath, S.A., Braun, V., Soliman, N. et al. Results of DREZ coagulations for pain related to plexus lesions, spinal cord injuries and postherpetic neuralgia. Acta neurochir 138, 364–369 (1996). https://doi.org/10.1007/BF01420297
Issue Date:
DOI: https://doi.org/10.1007/BF01420297