Microscissor DREZotomy for intractable brachial neuralgia

Abstract

Dorsal Root Entry Zone lesioning (DREZotomy), also known as Lissauer tractotomy, is a microsurgical technique originally described in the 1970s for managing intractable neuropathic pain and spasticity. This article reviews the historical evolution and technical nuances of DREZotomy, focusing on the methods established by Sindou and Nashold, including their respective approaches to incision and lesioning. A case of a patient with a pan brachial plexus injury and severe neuropathic pain is presented, where DREZotomy provided complete pain relief. The surgical technique, anatomical landmarks, and intraoperative considerations are described, along with potential complications affecting posterior column, spinocerebellar, and corticospinal pathways. This report highlights the role of DREZotomy as an effective intervention for neuropathic pain secondary to brachial plexus avulsion.