Treatment of refractory pain after brachial plexus avulsion with dorsal root entry zone lesions

OBJECTIVE: Significant numbers of patients experience intractable pain afte r brachial plexus root avulsions. Medications and surgical procedures such as amputation of the limb are often not successful in pain treatment. METHODS: Forty-seven patients with intractable pain after traumatic cervica l root avulsions were treated with dorsal root entry zone coagulation betwe en 1980 and 1998, The dorsal root entry zone coagulation procedure was perf ormed 4 months to 12 years after the trauma, and patients were monitored fo r up to 18 years (average follow-up period, 14 yr). RESULTS: Immediately after surgery, 75% of patients experienced significant pain reduction; this value was reduced to 63% during long-term follow-up m onitoring. Nine patients experienced major complications, including subdura l hematomas (n = 2) and motor weakness of the lower limb (n = 7). Improved coagulation electrodes with thermistors that could produce smaller and more -accurate lesion sizes, which were introduced in 1989, significantly reduce d the number of complications. CONCLUSION: Central deafferentation pain that persists and becomes intracta ble among patients with traumatic cervical root avulsions has been difficul t to treat in the past. Long-term follow-up monitoring of patients who unde rwent the dorsal root entry zone coagulation procedure in the cervical cord indicated that long-lasting satisfactory relief is possible for the majori ty of individuals, with acceptable morbidity rates.