Treatment of refractory pain after brachial plexus avulsion with dorsal root  entry zone lesions.
OBJECTIVE
Significant numbers of patients experience intractable pain after brachial plexus root avulsions. Medications and surgical procedures such as amputation of the limb are often not successful in pain treatment.


METHODS
Forty-seven patients with intractable pain after traumatic cervical root avulsions were treated with dorsal root entry zone coagulation between 1980 and 1998. The dorsal root entry zone coagulation procedure was performed 4 months to 12 years after the trauma, and patients were monitored for up to 18 years (average follow-up period, 14 yr).


RESULTS
Immediately after surgery, 75% of patients experienced significant pain reduction; this value was reduced to 63% during long-term follow-up monitoring. Nine patients experienced major complications, including subdural hematomas (n = 2) and motor weakness of the lower limb (n = 7). Improved coagulation electrodes with thermistors that could produce smaller and more-accurate lesion sizes, which were introduced in 1989, significantly reduced the number of complications.


CONCLUSIONS
Central deafferentation pain that persists and becomes intractable among patients with traumatic cervical root avulsions has been difficult to treat in the past. Long-term follow-up monitoring of patients who underwent the dorsal root entry zone coagulation procedure in the cervical cord indicated that long-lasting satisfactory relief is possible for the majority of individuals, with acceptable morbidity rates.
Samii
M
M
Department of Neurosurgery, Medical School Hannover, Germany.
Bear-Henney
S
S
Lüdemann
W
W
Tatagiba
M
M
Blömer
U
U
D001917:Brachial Plexus / Q000293:injuries*; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010148:Intractable Pain / Q000601:surgery*; D010166:Palliative Care; D011846:Radio Waves; D013126:Spinal Nerve Roots / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000601:surgery*