de Mendonça Cardoso Marcio, Gepp Ricardo, Caetano Henrique, Felipe Ricardo, Martins Bernardo
Department of Neurological Surgery, Sarah Network of Rehabilitation Hospitals, Brasilia, Brazil.
Department of Neurological Surgery, Sarah Network of Rehabilitation Hospitals, Brasilia, Brazil.
World Neurosurg. 2023 Sep;177:e466-e471. doi: 10.1016/j.wneu.2023.06.077. Epub 2023 Jun 24.
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.
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.
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).
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.
背根入髓区（DREZ）毁损术可用于治疗创伤性臂丛神经损伤患者的神经性疼痛。医学文献中手术的临床结果存在差异。我们旨在报告射频DREZ毁损术后的手术结果，并分析术前确定的脊髓损伤等预后因素。
我们进行了一项回顾性研究，纳入了57例经历过创伤性臂丛神经损伤且表现出对保守治疗方法无反应的神经性疼痛患者。他们接受了DREZ毁损术。我们定义了纳入和排除标准，收集了社会人口统计学和临床特征，并根据磁共振成像识别和分类脊髓损伤。我们应用统计检验来评估术后疼痛强度与放射学特征和社会人口统计学特征之间的关联。
术后即刻，50例患者（89.28%）的疼痛结果被认为良好或优秀。在最后一次随访时，39例患者（68.43%）的疼痛结果为良好或优秀。疼痛结果与所分析的变量（创伤与DREZ毁损术之间的时间间隔、脊髓损伤的存在、年龄、撕脱神经根的数量和疼痛类型）之间无关联（P>0.05）。
射频DREZ毁损术是治疗创伤性臂丛神经损伤后神经性疼痛的一种重要治疗方法。重要的是，我们发现脊髓损伤的存在与手术结果无关。
