Correlation of preoperative MRI with the long-term outcomes of dorsal root entry zone lesioning for brachial plexus avulsion pain

Andrew L. Ko, Alp Ozpinar, Jeffrey S. Raskin, Stephen T. Magill, Ahmed Raslan, Kim Burchiel

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Obj ective Lesioning of the dorsal root entry zone (DREZotomy) is an effective treatment for brachial plexus avulsion (BPA) pain. The role of preoperative assessment with MRI has been shown to be unreliable for determining affected levels; however, it may have a role in predicting pain outcomes. Here, DREZotomy outcomes are reviewed and preoperative MRI is examined as a possible prognostic factor. Methods?A retrospective review was performed of an institutional database of patients who had undergone brachial plexus DREZ procedures since 1995. Preoperative MRI was examined to assess damage to the DREZ or dorsal horn, as evidenced by avulsion of the DREZ or T2 hyperintensity within the spinal cord. Phone interviews were conducted to assess the long-term pain outcomes. Results?Between 1995 and 2012, 27 patients were found to have undergone cervical DREZ procedures for BPA. Of these, 15 had preoperative MR images of the cervical spine available for review. The outcomes were graded from 1 to 4 as poor (no significant relief), good (more than 50% pain relief), excellent (more than 75% pain relief), or pain free, respectively. Overall, DREZotomy was found to be a safe, efficacious, and durable procedure for relief of pain due to BPA. The initial success rate was 73%, which declined to 66% at a median follow-up time of 62.5 months. Damage to the DREZ or dorsal horn was significantly correlated with poorer outcomes (p = 0.02). The average outcomes in patients without MRI evidence of DREZ or dorsal horn damage was significantly higher than in patients with such damage (3.67 vs 1.75, t-test; p = 0.001). A longer duration of pain prior to operation was also a significant predictor of treatment success (p = 0.004). Con clusions?Overall, the DREZotomy procedure has a 66% chance of achieving meaningful pain relief on longterm follow-up. Successful pain relief is associated with the lack of damage to the DREZ and dorsal horn on preoperative MRI.

Original languageEnglish (US)
Pages (from-to)1470-1478
Number of pages9
JournalJournal of Neurosurgery
Volume124
Issue number5
DOIs
StatePublished - May 1 2016

Fingerprint

Brachial Plexus
Spinal Nerve Roots
Pain
Spinal Cord
Spine
Databases
Interviews
Spinal Cord Dorsal Horn
Therapeutics

Keywords

  • Brachial plexus avulsion
  • Dorsal root entry zone
  • DREZotomy
  • Neuropathic pain

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Correlation of preoperative MRI with the long-term outcomes of dorsal root entry zone lesioning for brachial plexus avulsion pain. / Ko, Andrew L.; Ozpinar, Alp; Raskin, Jeffrey S.; Magill, Stephen T.; Raslan, Ahmed; Burchiel, Kim.

In: Journal of Neurosurgery, Vol. 124, No. 5, 01.05.2016, p. 1470-1478.

Research output: Contribution to journalArticle

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abstract = "Obj ective Lesioning of the dorsal root entry zone (DREZotomy) is an effective treatment for brachial plexus avulsion (BPA) pain. The role of preoperative assessment with MRI has been shown to be unreliable for determining affected levels; however, it may have a role in predicting pain outcomes. Here, DREZotomy outcomes are reviewed and preoperative MRI is examined as a possible prognostic factor. Methods?A retrospective review was performed of an institutional database of patients who had undergone brachial plexus DREZ procedures since 1995. Preoperative MRI was examined to assess damage to the DREZ or dorsal horn, as evidenced by avulsion of the DREZ or T2 hyperintensity within the spinal cord. Phone interviews were conducted to assess the long-term pain outcomes. Results?Between 1995 and 2012, 27 patients were found to have undergone cervical DREZ procedures for BPA. Of these, 15 had preoperative MR images of the cervical spine available for review. The outcomes were graded from 1 to 4 as poor (no significant relief), good (more than 50{\%} pain relief), excellent (more than 75{\%} pain relief), or pain free, respectively. Overall, DREZotomy was found to be a safe, efficacious, and durable procedure for relief of pain due to BPA. The initial success rate was 73{\%}, which declined to 66{\%} at a median follow-up time of 62.5 months. Damage to the DREZ or dorsal horn was significantly correlated with poorer outcomes (p = 0.02). The average outcomes in patients without MRI evidence of DREZ or dorsal horn damage was significantly higher than in patients with such damage (3.67 vs 1.75, t-test; p = 0.001). A longer duration of pain prior to operation was also a significant predictor of treatment success (p = 0.004). Con clusions?Overall, the DREZotomy procedure has a 66{\%} chance of achieving meaningful pain relief on longterm follow-up. Successful pain relief is associated with the lack of damage to the DREZ and dorsal horn on preoperative MRI.",
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