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Dorsal root entry zone lesions for post-amputation pain.

S C Saris, R P Iacono, B S Nashold

    Journal of Neurosurgery
    |January 1, 1985
    PubMed
    Summary
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    Dorsal root entry zone (DREZ) coagulation offered pain relief for 36% of patients with chronic post-amputation pain. The procedure showed promise for phantom limb pain and traumatic amputations with root avulsion.

    Area of Science:

    • Neurosurgery
    • Pain Management
    • Rehabilitation Medicine

    Background:

    • Chronic pain is a significant challenge after amputation, affecting the stump, phantom limb, or both.
    • Previous surgical interventions like rhizotomy, cordotomy, stump revision, and dorsal column stimulation have yielded limited success.
    • Post-amputation pain significantly impacts patient quality of life and functional recovery.

    Purpose of the Study:

    • To evaluate the efficacy of dorsal root entry zone (DREZ) coagulation in managing chronic post-amputation pain.
    • To identify patient subgroups who may benefit most from DREZ coagulation.
    • To assess the long-term outcomes of DREZ coagulation for refractory post-amputation pain.

    Main Methods:

    • A cohort of 22 patients with post-amputation pain (due to trauma, gangrene, or cancer) underwent DREZ coagulation.

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  • Patients were followed for a period ranging from 6 months to 4 years post-surgery.
  • Pain relief and functional outcomes were systematically assessed.

    • Main Results:

    • Overall, 36% (8 out of 22) of patients experienced pain relief following the DREZ procedure.
    • Good outcomes were observed in 67% of patients with phantom limb pain alone and 83% with traumatic amputations and root avulsion.
    • Patients with combined phantom and stump pain, or stump pain only, reported poor results.

    Conclusions:

    • DREZ coagulation provides a limited but distinct therapeutic option for specific cases of post-amputation pain.
    • The procedure is most effective for phantom limb pain and traumatic amputations involving root avulsion.
    • Further research is warranted to refine patient selection and optimize outcomes for DREZ coagulation in amputation pain management.