Abstract
DREZ thermocoagulation of spinal cord dorsal horns was performed in 15 patients with intractable pain after brachial plexus avulsion. A good result (reduction to 25% or less of preoperative pain) was obtained in 80% of subjects, a reasonable result (FAIR) (reduction to 25-75% of preoperative pain) in the remaining 20% of subjects.
A postoperative neurological deficit developed in 27% of subjects in this group. The postoperative neurological deficit disappeared completely or partially in all these subjects.
Standard size of the thermocoagulation lesion and accurate placement of the radiofrequency electrode are the most important factors in reducing the postoperative neurological deficit. The electrophysiological method of Fazl et al. (1995) was used to locate the posterolateral sulcus.
DREZ thermocoagulation was performed in a group of 5 paraplegic patients sustaining traumatic transversal spinal cord lesions to relieve intractable pain in the lower extremities. Good results were obtained in 40% of subjects, reasonable results in 40%, and poor or no results in 20% of subjects.
DREZ thermocoagulation is actually the most successful method in the treatment of intractable pain after brachial plexus avulsion. Worse results were obtained in patients with traumatic spinal cord lesions.
This was most probably due to the multifactorial pathogenesis of pain.