[Destruction of the entry zone of the posterior roots combined with selective rhizotomy in pain syndromes due to a lesion of the brachial plexus].

Pain syndromes caused by traumatic preganglionic avulsion of roots forming the brachial plexus are among the most severe forms which do not respond to nonoperative treatment. According to the data in the literature and our experience, operation for destruction of the posterior root entry zones is the most substantiated and effective method for the management of these pain syndromes. In this operation, however, poor results and recurrences are encountered in some cases. In view of this, the authors suggest combining destruction of the entry zone of the posterior roots with posterior selective rhizotomy. These combined operations are indicated in prevalent spreading of the pain syndrome in the limb dermatomes related to the torn roots. Operations were carried out on 85 patients. They are followed up since 1982. Among 48 patients treated by destruction of the posterior root entry zones 40 had a good result, i.e., practically complete regression of the pain syndrome occurred in 5 patients, the result was moderate--the pain syndrome abated approximately by 50%, in 3 patients the result was poor, the pain syndrome regressed by 25% and less. Destruction of the entry zones of the posterior root was combined with posterior selective rhizotomy in 37 patients. In 35 of them the result was good, in 2--moderate. Thus, destruction of the entry zones of the posterior roots in combination with posterior selective rhizotomy is a substantiated and effective method for the management of the pain syndrome in traumatic affections of the brachial plexus.