Comparative outcomes of microsurgical dorsal root entry zone lesioning (DREZotomy) for intractable neuropathic pain in spinal cord and cauda equina injuries

Neurosurgical Review, 2025 · DOI: https://doi.org/10.1007/s10143-024-03136-y · Published: January 1, 2025

Spinal Cord Injury Pain Management Surgery

Simple Explanation

This study compares the effectiveness of DREZotomy, a surgical procedure, in treating neuropathic pain for patients with spinal cord injuries (SCI) versus cauda equina injuries (CEI). It examines whether DREZotomy provides better pain relief for one group over the other. The study found that while both groups experienced pain improvement initially, CEI patients reported significantly better long-term pain reduction compared to SCI patients. This suggests DREZotomy may be a more effective long-term solution for CEI-related neuropathic pain. The research also highlights that patients with 'border zone pain' (localized pain with clear boundaries) experienced better long-term relief than those with 'diffuse pain' (widespread pain). This indicates that the type of pain distribution affects DREZotomy's success.

Study Duration

January 2013 and December 2023

Participants

12 patients (6 with SCI and 6 with CEI)

Evidence Level

Not specified

Key Findings

1
Patients with CEI had significantly better long-term pain reduction after DREZotomy compared to those with SCI.
2
The presence of border zone pain was a predictor of favorable outcomes following DREZotomy.
3
Patients with diffuse pain below the level of spinal cord injury responded poorly to DREZotomy and had a higher rate of pain recurrence.

Research Summary

This study compares the surgical outcomes of DREZL between patients with SCI and those with CEI to investigate predictors of favorable operative outcomes. The CEI group demonstrated significant pain improvement and favorable outcomes in the long-term follow-up compared with the preoperative baseline values. The long-term outcome was most favorable in patients with border zone neuropathic pain, whereas those with diffuse pain below the level of SCI responded poorly to the procedure and had a high recurrence rate.

Practical Implications

Patient Selection

CEI patients with neuropathic pain are better candidates for DREZotomy than SCI patients.

Pain Type Consideration

Border zone pain predicts favorable DREZotomy outcomes, while diffuse pain indicates a poorer prognosis.

Alternative Treatments

SCI patients with diffuse pain may benefit more from neuromodulation or intrathecal drug delivery instead of DREZotomy.

Study Limitations

1
Small sample size may affect the significance of some analyses.
2
Limited by being a retrospective study.
3
Procedure is less commonly used for SCI and CEI compared to brachial plexus avulsion injury pain.

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