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

Area of Science:

• Neurosurgery
• Pain Management
• Neurology

Background:

• Brachial plexus avulsion (BPA) injuries often result in severe deafferentation pain.
• Dorsal root entry zone (DREZ) lesioning is an established treatment for BPA-induced pain.
• Anatomical distortions post-BPA complicate surgical identification of neural structures.

Purpose of the Study:

• To describe a modified surgical technique for DREZ lesioning in BPA patients.
• To detail the use of advanced intraoperative neuromonitoring (IONM) for DREZ identification.
• To analyze long-term outcomes of DREZ lesioning, including pain, quality of life, and complications.

Main Methods:

• A single-center retrospective case series of 44 patients undergoing DREZ lesioning with IONM for BPA (2012-2022).
• Pre- and postoperative pain scores (Visual Analog Scale - VAS) and quality of life (QOL) scores were analyzed.
• Surgical approach modifications and IONM techniques were documented.

Main Results:

• Mean VAS score improved significantly from 8.9 at baseline to 1.87 at discharge and 4.1 at long-term follow-up (p < 0.0001).
• Mean QOL scores improved from 3.7 to 7.4 (p < 0.0001) at long-term follow-up.
• Long-term outcomes were rated as good (39%), fair (29%), and poor (32%); 55% reduced pain medication.

Conclusions:

• Surgical technique modifications enhance DREZ exposure, while IONM aids identification in complex cases.
• DREZ lesioning offers significant long-term pain reduction and improved quality of life for BPA patients.
• The study highlights the efficacy of combined surgical and neuromonitoring advancements.