Phantom phenomena (phantom arm) following cervical root avulsion. Effect of dorsal root entry zone thermocoagulation

We report on nine male patients with cervical root avulsions and brachial plexus injuries following traffic accidents. These non-amputees (mean age 33.7 years) had a phantom arm beside the paralysed arm. Cervical root avulsions were demonstrated either by myelography or surgically. Mostly the roots C5-Th1 were affected. Eight of the nine patients had Horner's syndrome on the side of the root avulsion. The phantom arm appeared immediately after the accident, except in one patient who was symptom-free for 2 weeks. In two cases the phantom arm disappeared spontaneously. Four patients underwent a DREZ lesion. After surgery the phantom arm disappeared, and three of the patients became painfree, while one patient experienced pain relief of 20% to 50%. Reviewing the literature it is assumed that phantom limb following injury to the brachial plexus indicates cervical root avulsion. In such cases Horner's syndrome is a good indication for lower cervical root avulsion (C8-Th2).