Microsurgical DREZotomy for Refractory Neuralgia Following Traumatic Brachial Plexus Injury: A 10-Year Outcome Analysis

Abstract

Neuropathic pain following traumatic brachial plexus injury can be severe and may persist despite prolonged medical treatment. Dorsal root entry zone (DREZ) lesioning is an established surgical option for refractory deafferentation pain. This study evaluated the long-term pain relief and safety of a modified microsurgical DREZotomy technique using micro-scissors instead of the traditional thermal coagulation.

We retrospectively reviewed patients who underwent micro-scissor DREZotomy (MDZ) for refractory neuropathic pain following traumatic brachial plexus avulsion at a single tertiary trauma center between 2014 and 2024. Pain severity was assessed using the visual analog scale (VAS) preoperatively, immediately postoperatively, and at long-term follow-up. To distinguish the efficacy of the primary procedure from that of repeat surgery, the pre-redo VAS was considered the final primary-procedure outcome in patients subsequently undergoing redo MDZ. Redo cases were analyzed separately according to indication, interval to repeat surgery, and subsequent pain outcome.

Seventy-one patients were identified, of whom 55 had adequate follow-up. Mean follow-up was 76.9 ± 34.05 months. Mean VAS decreased from 9.09 ± 0.89 preoperatively to 2.80 ± 2.30 immediately after MDZ (mean reduction: 6.29 points; 95% confidence interval: 5.60–6.98; p < 0.001). At the primary-procedure endpoint, mean VAS remained at 2.76 ± 2.68, with 33 patients (60.0%) achieving an excellent outcome, 13 (23.6%) a good outcome, 4 (7.3%) a partial outcome, and 5 (9.1%) a poor outcome. Five patients (9.1%) underwent repeat MDZ: two for inadequate or absent initial pain relief and three for recurrent/worsening pain after initial improvement. The median interval to redo surgery was 11.7 months (range: 4.8–56.2 months). At final follow-up, mean VAS was 2.27 ± 2.09, with 36 patients (65.5%) having an excellent outcome and 15 (27.3%) a good outcome. Postoperative neurological worsening occurred in three patients (5.5%).

MDZ provided substantial and durable pain relief following traumatic brachial plexus avulsion. Primary MDZ achieved satisfactory long-term pain control in 83.6% of patients, while repeat MDZ provided additional pain relief in a small subgroup with inadequate initial response or recurrent pain, resulting in excellent or good outcomes in 92.7% of the overall cohort at final follow-up.