Microsurgical junctional DREZ coagulation for treatment of deafferentation pain syndromes

In the treatment of intractable deafferentation pain, different procedures in the DREZ have proved most effective. For most of the spot-like techniques special equipment is mandatory. In this study the technique and the results of junctional DREZ coagulation for treatment of different pain syndromes with the help of bipolar forceps is presented.

In 40 patients with intractable deafferentation pain syndromes a junctional DREZ coagulation lesion along the entire dorsolateral fissure of the involved spinal cord segments was made using bipolar forceps. Etiologies of the pain included avulsion of the brachial plexus (21 cases), postherpetic pain (4 cases), phantom pain (3 cases), peripheral nerve injury (3 cases), reflex sympathetic dystrophy (2 cases), spinal cord transsection (1 case), and syringomyelia (6 cases).

Of 21 patients who underwent junctional DREZ surgery for pain because of brachial plexus avulsion 10 (47.6%) had complete, 7 (33.3%) excellent, 3 (14.3%) good, and 1 (4.7%) fair pain relief (follow-up 20 to 120 months). In the group of 19 patients (follow-up 6 to 84 months) with pain syndromes other than postavulsion pain we achieved excellent results in 10 cases (52.6%), good in 8 (42.1%) and no pain relief in 1 case (5.3%). Transient sensory neurological disturbances lasting up to 8 weeks were observed in 6 (15%) cases; permanent sensory and motor deficit in 1 (2.5%) case.

Clinical results of junctional coagulation DREZ lesion for the treatment of deafferentation pain syndromes are promising. There is no need for special equipment for creating DREZ lesions. The lesions are precisely placed with only a bipolar electrode. Postoperative complications are rare and transient. We believe that the junctional coagulation includes the entire dorsolateral sulcus and DREZ structures important for deafferentation pain.