Publication: Comparative outcomes of microsurgical dorsal root entry zone lesioning (DREZotomy) for intractable neuropathic pain in spinal cord and cauda equina injuries
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Issued Date
2025-12-01
Resource Type
ISSN
03445607
eISSN
14372320
Scopus ID
2-s2.0-85213883285
Pubmed ID
39747752
Journal Title
Neurosurgical Review
Volume
48
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Neurosurgical Review Vol.48 No.1 (2025)
Suggested Citation
Sitthinamsuwan B., Ounahachok T., Pumseenil S., Nunta-Aree S. Comparative outcomes of microsurgical dorsal root entry zone lesioning (DREZotomy) for intractable neuropathic pain in spinal cord and cauda equina injuries. Neurosurgical Review Vol.48 No.1 (2025). doi:10.1007/s10143-024-03136-y Retrieved from: https://hdl.handle.net/20.500.14740/20067
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Abstract
Treatment of neuropathic pain in patients with spinal cord injury (SCI) and cauda equina injury (CEI) remains challenging. Dorsal root entry zone lesioning (DREZL) or DREZotomy is a viable surgical option for refractory cases. This study aimed to compare DREZL surgical outcomes between patients with SCI and those with CEI and to identify predictors of postoperative pain relief. We retrospectively analyzed 12 patients (6 with SCI and 6 with CEI) with intractable neuropathic pain who underwent DREZL. The data collected were demographic characteristics, pain distribution, and outcomes assessed by numeric pain rating scores. Variables and percentages of pain improvement at 1 year and long-term were statistically compared between the SCI and CEI groups. The demographic characteristics and percentage of patients who experienced pain improvement at 1 year postoperatively did not differ between the groups. Compared with the SCI group, the CEI group presented significantly better long-term pain reduction (p = 0.020) and favorable operative outcomes (p = 0.015). Patients with border zone pain had significantly better long-term pain relief and outcomes than did those with diffuse pain (p = 0.008 and p = 0.010, respectively). Recurrent pain after DREZL occurred in the SCI group but not in the CEI group. DREZL provided superior pain relief in patients with CEI. The presence of border zone pain predicted favorable outcomes. CEI patients or SCI patients with border zone pain are good surgical candidates for DREZL, whereas SCI patients with below-injury diffuse pain are poor candidates.