Dorsal Root Entry Zone (DREZ)

Dorsal root entry zone (DREZ) lesioning is a treatment option for patients with treatment resistant pain. DREZ lesioning is most often used in the setting of brachial plexus injuries, but can also be used in patients with cancer-related pain. Although it is one of the more invasive procedures done for pain, it can provide the significant relief.

How Does it Work?

DREZ lesioning aims to interrupt abnormal signals related to chronic pain from entering the spinal cord. During the surgery, the spine is exposed and Dr Pouratian makes very precise cuts measuring less than 3 mm in the spine to interrupt the painful sensations. Specialized monitoring of the brain and spine is used throughout to maximize the safety of the procedure.

Am I A Good Candidate?

DREZ lesioning is a treatment option for individuals who have not found relief through other treatment options for chronic pain. In particular, individuals who suffer from pain related to brachial plexus injuries (or avulsions) can benefit from this procedure. Other patients who many benefit are those with cancer-related pain that affects the nerves or brachial plexus.

The Procedure

DREZ lesioning involves removal of the back part of the vertebral bones to expose the spine. The covering of the spine, or dura, is opened to expose the spine itself. Then, very precise incisions are made precisely where the nerves enter (or used to enter) the spinal cord.

While the surgery itself can cause significant muscle pain, it can be immediately effective for the pain that it is targeting, with results in ~70% of patients that can last >5-10 years. The most important risk of this surgery is a 8-10% risk of weakness, which is why it is important to have an experienced surgeon do this surgery and to use the most advanced and experience spinal monitoring available.

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