DREZ Lesioning for Brachial Plexus Injury Pain
Dorsal root entry zone (DREZ) lesioning is a specialized neurosurgical option for selected severe deafferentation pain after brachial plexus avulsion injury.
Pain and neuromodulation pathway
From pain mapping to durable management
Goals
Clarify pain relief, function, sleep, medication burden, and quality-of-life priorities.
Mapping
Identify whether symptoms follow a nerve, spinal pathway, facial pain syndrome, or broader pain pattern.
Treatment review
Review therapy, medications, injections, blocks, surgery, imaging, and prior response.
Option selection
Choose stimulation, intrathecal pain therapy, lesioning, nerve surgery, or continued non-surgical care.
Trial or procedure
Use trials when appropriate, or proceed with the selected targeted treatment plan.
Long-term care
Adjust programming, dosing, refills, precautions, and follow-up over time.
Goal-directed care
Treatment planning starts with pain relief, function, sleep, medication burden, and quality-of-life goals.
Selective options
Surgery is considered when medication, therapy, injections, or conservative care are not enough.
Adjustable follow-up
Stimulation and pump therapies require ongoing management to keep treatment aligned with goals.
Overview
Brachial plexus avulsion injuries can cause severe deafferentation pain when nerve roots are torn away from the spinal cord. DREZ lesioning is a specialized procedure that targets abnormal pain signaling at the dorsal root entry zone.
When it may be considered
DREZ lesioning may be considered for selected patients with severe, refractory pain after brachial plexus root avulsion, especially when pain is disabling and other treatments have failed.
Evaluation
Evaluation includes review of injury anatomy, imaging, electrodiagnostic studies, prior surgeries, pain pattern, functional goals, and other treatment attempts.
Risks and expectations
DREZ lesioning is a serious neurosurgical procedure. It can reduce pain in selected patients, but risks and realistic expectations must be reviewed carefully.
Dr. Barone’s approach
Dr. Barone combines brachial plexus and functional neurosurgery experience to evaluate whether DREZ lesioning is appropriate, or whether another pain strategy is safer.
Frequently asked questions
What is DREZ lesioning? +
DREZ lesioning targets the dorsal root entry zone of the spinal cord to reduce severe deafferentation pain, most classically after brachial plexus avulsion injury.
Who may be a candidate? +
Candidates are highly selected, usually with severe, refractory pain after root avulsion that has not responded to other treatments.
Is DREZ used for all brachial plexus pain? +
No. It is reserved for specific severe pain patterns, especially avulsion-related deafferentation pain, and requires careful risk-benefit discussion.
Considering treatment for Brachial plexus avulsion pain?
Dr. Barone evaluates new patients and referrals at Houston Methodist Hospital, Houston. Patients from outside Houston, across the United States, and internationally are welcome.