Long-Term Outcomes of Dorsal Root Entry Zone Lesioning for Neuropathic Pain After Brachial Plexus Avulsion: A 10-Year Follow-up Study.

Background and objectives: Neuropathic pain resulting from brachial plexus avulsion (BPA) severely affects patients' quality of life and is often resistant to standard treatments. Surgical interventions, such as dorsal root entry zone (DREZ) lesioning, have shown promise in treating chronic pain. However, comprehensive long-term data on the effectiveness and safety of DREZ lesioning remain sparse. We aimed to evaluate the long-term efficacy and safety of DREZ lesioning for managing BPA-related neuropathic pain over a minimum 10-year period.

Methods: We conducted a retrospective review of patients undergoing DREZ lesioning for BPA-induced neuropathic pain from 2004 to 2014. Pain intensity was measured using the Numeric Rating Scale, and quality of life was assessed through validated questionnaires (Short Form-36 and EuroQol-5D). Surgical complications were systematically documented. Statistical analyses were conducted to compare preoperative and long-term postoperative outcomes.

Results: Fifty-two patients completed at least 10 years of follow-up. The mean preoperative Numeric Rating Scale score of 8.63 significantly decreased to 2.44 at long-term follow-up (P < .001). Initially, after surgery, 37 patients (71.2%) achieved complete pain relief. At the final assessment, 28 patients (53.8%) experienced complete pain relief, and another 4 patients (7.7%) reported significant improvement. Apart from the health transition domain in the short form-36 and the mobility and usual activities domains in the EuroQol-5D, all other domains in both scales showed significant improvement (P < .001). The safety profile was favorable, with mild proprioceptive sense disturbance (9/52) and motor weakness (1/52) being the primary complications.

Conclusion: DREZ lesioning provides significant, durable pain relief and enhances quality of life for patients suffering from neuropathic pain after BPA, demonstrating a tolerable safety profile over a decade of follow-up.