Indian Journal of Neurotrauma 2014; 11(01): 27-29
DOI: 10.1016/j.ijnt.2014.04.003
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Drezotomy in the management of post brachial plexus injury neuropathic pain: Preliminary results

Satyakam Baruah
,
B. Indira Devi
,
Dhananjay I. Bhat
,
Dhaval Shukla

Subject Editor:
Further Information

Publication History

11 March 2014

28 April 2014

Publication Date:
06 April 2017 (online)

Abstract

Objective

To share our experience of DREZOTOMY in the management of post brachial plexus injury neuropathic pain.

Method

Records of patients with severe neuropathic pain following brachial plexus injury who underwent microsurgical C4-T1 DREZOTOMY were analyzed. Pain relief in the immediate postoperative period, 6 weeks and 6 months was analyzed.

Results

Total of 7 patients from July 2010 to May 2013 were included in the study. Mean age was 41.1 (26–63). There were 6 male and 1 female patients. Five patients had right-sided pain and 2 had left sided dysesthetic pain. All patients had intractable pain not relieved by medications and was affecting their activities of daily living (ADL's). After psychological counseling and detailed analysis cervical laminectomy and DREZOTOMY was performed. Findings were that the posterior rootlets were absent from the DREZ, arachnoid over the area was dull and multiple microcysts were present. Pain relief was assessed in the immediate postoperative period and later. Control of pain was graded as absence or minimal pain, requiring minimal or no analgesics in 3 patients (VAS 0 OR 1), moderate pain as requiring atypical analgesics in 4 patients (VAS 3–4). Pain control at 6 weeks follow up was good for 2 and moderate for 2 patients. At 6 months showed good pain relief in 2 patients and moderate for 2.

Conclusion

Patients whose ADL'S are affected by such pain, microsurgical DREZOTOMY can provide good relief thereby helping them to get back to a better quality of life post trauma.

 
  • References

  • 1 Sindou M., Mertens P.. Ablative Surgery for Spasticity. Youmans Neurological Surgery 6th ed. 2011; 1031-1033 Chap 90
  • 2 Nashold Jr. B.S., Urban B., Zorub D.S.. Phantom relief by focal destruction of substantia gelatinosa of Rolando. In: Bonica J.J., Albe-Fessard D.. eds. Advances in Pain Research and Therapy. 1976. 1 Raven Press; New York: 959-963
  • 3 Prestor B.. Microcoagulation of junctional dorsal root entry zone is effective treatment of brachial plexus avulsion pain: long-term follow-up study. Croat Med J 2006; April 47 (02) 271-278
  • 4 Sindou M.P., Blondet E., Emery E., Mertens P.. Microsurgical lesioning in the dorsal root entry zone for pain due to brachial plexus avulsion: a prospective series of 55 patients. J Neurosurg 2005; Jun 102 (06) 1018-1028
  • 5 Thomas D.G.T., Sheehy J.P.R.. Dorsal root entry zone lesions (Nashold's procedure) for pain relief following brachial plexus avulsion. J Neurol Neurosurg Psychiatr 1983; 46: 924-928
  • 6 Emery E., Blondet E., Mertens P., Sindou M.. Microsurgical DREZotomy for pain due to brachial plexus avulsion: long-term results in a series of 37 patients. Stereotact Funct Neurosurg 1997; 68 1–4 Pt 1 155-160
  • 7 Thomas D.G.T., Kitchen N.D.. Long term follow up of dorsal root entry zone lesions in brachial plexus avulsion. J Neurol Neurosurg Psychiatr 1994; 57: 737-738