Revision Dorsal Root Entry Zone Lesioning for Intractable Deafferentation Pain After Brachial Plexus Avulsion

Abstract

Background Neuropathic pain following brachial plexus avulsion (BPA) represents one of the most refractory pain syndromes in neurosurgical practice. Dorsal root entry zone (DREZ) lesioning provides effective relief in most cases; however, pain may recur due to incomplete lesioning or neural plasticity, necessitating revision (redo) surgery. This study evaluates the outcomes of redo DREZotomy in patients with recurrent deafferentation pain following traumatic BPA.

Methods A retrospective, single-center review of six patients who underwent microsurgical DREZotomy for BPA-related neuropathic pain followed by revision DREZotomy for recurrence of pain between 2014 and 2025. Pain intensity was assessed using the visual analogue scale preoperatively, postprimary surgery, preredo, and postredo, along with documentation of the time to recurrence.

Results The mean age of redo DREZotomy patients was 45.17  15.42 years (range: 26–64). The preprimary DREZ pain score was 9.33  0.82, decreasing significantly to 5.17  2.32 postoperatively (p ¼ 0.012). The preredo pain score was 9.17  0.75, which improved markedly to 3.00  1.67 following redo surgery (p < 0.001). A significant positive correlation was observed between the degree of pain reduction and time to recurrence (r ¼ 0.83, p ¼ 0.041), suggesting that greater initial pain relief predicted longer pain-free intervals. At final follow-up, 83.3% of patients achieved good pain relief, and 16.7% had poor outcomes.

 Conclusion Redo DREZotomy provides a safe and effective salvage option for patients with recurrent neuropathic pain following BPA. The procedure yields significant and durable pain relief, comparable to primary DREZotomy