Retrospective Study of 57 Patients Submitted to Dorsal Root Entry Zone Lesioning by Radiofrequency for Brachial Plexus Avulsion Pain

Marcio de Mendonça Cardoso; Ricardo Gepp; Henrique Caetano; Ricardo Felipe; Bernardo Martins

doi:10.1016/j.wneu.2023.06.077

Retrospective Study of 57 Patients Submitted to Dorsal Root Entry Zone Lesioning by Radiofrequency for Brachial Plexus Avulsion Pain

World Neurosurg. 2023 Jun 24:S1878-8750(23)00840-9. doi: 10.1016/j.wneu.2023.06.077. Online ahead of print.

Authors

Marcio de Mendonça Cardoso¹, Ricardo Gepp², Henrique Caetano², Ricardo Felipe², Bernardo Martins³

Affiliations

¹ Department of Neurological Surgery, Sarah Network of Rehabilitation Hospitals, Brasilia, Brazil. Electronic address: marcio.mendonca.cardoso@gmail.com.
² Department of Neurological Surgery, Sarah Network of Rehabilitation Hospitals, Brasilia, Brazil.
³ Department of Radiology, Sarah Network of Rehabilitation Hospitals, Brasilia, Brazil.

PMID: 37356482
DOI: 10.1016/j.wneu.2023.06.077

Abstract

Background: Dorsal root entry zone (DREZ) lesioning may be used to treat neuropathic pain in patients with traumatic brachial plexus injuries. The clinical outcome after surgery is variable in the medical literature. We aimed to report the surgical outcome after DREZ lesioning by radiofrequency and to analyze prognostic factors such as the presence of a spinal cord injury identified before surgery.

Methods: We conducted a retrospective study that included 57 patients who had experienced traumatic brachial plexus injuries and exhibited neuropathic pain that did not respond to conservative treatment methods. They were submitted to DREZ lesioning. We defined the inclusion and exclusion criteria, collected sociodemographic and clinical characteristics, and identified and classified spinal cord lesions based on magnetic resonance imaging. We applied statistical tests to evaluate the association between pain intensity after surgery and the radiological profile and sociodemographic characteristics.

Results: Immediately after surgery, the pain outcome was considered good or excellent in 50 patients (89.28%). At the last follow-up, it was good or excellent in 39 patients (68.43%). There was no association (P > 0.05) between the pain outcome and the variables analyzed (time interval between trauma and DREZ lesioning, presence of spinal cord injury, age, the number of avulsed roots, and the type of pain).

Conclusions: DREZ lesioning using radiofrequency represents a significant therapeutic approach for managing neuropathic pain after a traumatic brachial plexus injury. Importantly, we found that the presence of a spinal cord injury is not associated with the surgical outcome.

Keywords: Brachial plexus avulsion; Dorsal root entry zone; Neuropathic pain; Surgery.