Dorsal root entry zone lesions (Nashold's procedure) in brachial plexus avulsion

Dorsal root entry zone coagulation (DREZ) lesions for pain were made in 41 patients at the National Hospitals during 1980 through 1983. In 34 patients the operation was an attempt to relieve pain due to avulsion of the brachial plexus. Of these patients, 95% were male and 91% had received their injury in road traffic accidents. The follow-up period is 4 to 44 months. Pain relief was good in 62%, fair in 24%, and poor in 14%. Postoperative motor or sensory changes occurred in 50% of the patients, but these were significant in only 12%. In later patients in this series, pre-, peri-, and postoperative monitoring of somatosensory evoked potentials was used. Evoked potential monitoring indicated subclinical posterior column damage ipsilateral to avulsion before DREZ lesion making in about 50% of the cases; in some cases, postoperative changes were detected.