Intraoperative Ultrasound Using Dorsal Root Entry Zone Lesioning: A Way to Guide Intraspinal Cord Therapeutic Lesions

Dorsal root entry zone (DREZ) lesioning is an effective method to treat refractory neuropathic pain in patients with radicular avulsion. In this procedure, we penetrate the spinal cord with a radiofrequency electrode using the posterior lateral sulcus as a guide. The intraspinal electrode trajectory has to be angled medially about 25°-45° to spare the corticospinal tract, which lies lateral to the DREZ, and also to spare the posterior column, which lies medial to it. Here we present a case of a patient with radicular avulsion lesion of rootlets of the cervical spinal cord successfully treated with DREZ lesioning using intraoperative ultrasound as a guide to perform the spinal cord lesions. The use of intraoperative ultrasound during DREZ lesioning in patients with radicular avulsion improves the neurosurgeon ability to precisely localize the posterior lateral sulcus and also to better define the correct angulation of the trajectory.