Micro-DREZ for Brachial Neuralgia

Dr Deepak Agrawal

Additional Professor, Neurosurgery

AIIMS

“Pain is a more terrible lord of mankind than even

death itself”

PAIN

Dr. Albert Schweitzer

(1875-1965)

Deafferentation pain

Pain or dysesthesia caused by interruption of the

peripheral or central afferent input in the central

nervous system

Sweet WH. Deafferentation pain in man. Appl Neurophysiol. 1988;51:117–27.

BRACHIAL NEURALGIA

More than 500 patients/ year at AIIMS

itself

70% will have brachial Neuralgia

BRACHIAL PLEXUS INJURIES

Microsurgical DREZ-otomy was introduced in 1972

Anatomical studies of the human dorsal root entry zone (DREZ)

showing a topographical segregation of the afferent fibers

according to their size and functional destinations.

MICROSURGICAL DREZ

MICRO DREZ- ANATOMY

MICRO DREZ- ANATOMY

TYPES OF DREZ

DREZ AREA

2 mm deep microsurgical lesion

directed at a 45 degrees angle in

the posterolateral sulcus and

penetrating the dorsal root entry

zone in its ventrolateral aspect, at

the level of all the rootlets

considered involved in spasticity

(and pain)

MICRO DREZ

It destroys mainly the lateral

(nociceptive) and central (myotatic)

afferent fibers as well as the

facilitatory medial part of the

Lissauer tract, while sparing most

of the medial (lemniscal) fibers, the

suppressor lateral part of the

Lissauer tract, and more or less of

the dorsal horn (DH).

EXPOSURE

DREZ SURGERY

POSTOP

• Excess of spasticity, especially when associated with severe pain (Seen in

post-Stroke patients in in Multiple Sclerosis)

• Well-localized cancer pain, such as Pancoast syndrome

• Neuropathic pain due to: brachial plexus injuries; cauda equina and/or

spinal cord lesions (especially for pain corresponding to segmental lesions);

• Peripheral nerve injuries, amputation, herpes

OTHER INDICATIONS

MICROSURGICAL DREZOTOMY

• 44 patients of SCI with severe neuropathic pain

•

Follow-up ranged from 1 to 20 years (mean 6 yrs)

• Immediate pain relief was obtained in 70% of patients and

was long-lasting in 60% of the total series.

• Good long-term results were obtained in 68% of the patients

MICROSURGICAL DREZOTOMY

• Started doing in March 2014

• Total of 8 cases (Including one for Post traumatic severe UL spasticity)

• All have become pain free

• No new deficits/ morbidity/ mortality

AIIMS SERIES

• Is a relatively inexpensive procedure

• Does not require any special equipment

• Should be the preferred treatment in Brachial Neuralgia

• May be also considered for severe spasticity &/or pain in post stroke

patients, SCI patients & pain associated with malignancy

CONCLUSIONS- MICRO DREZ

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