TY - JOUR T1 - DREZotomy in the treatment of deafferentation pain: Review of results and analysis of predictive factors for success JO - Neurocirugía (English edition) T2 - AU - Montalvo Afonso,Antonio AU - Ruiz Juretschke,Fernando AU - González Rodrigálvarez,Rosario AU - Mateo Sierra,Olga AU - Iza Vallejo,Begoña AU - García Leal,Roberto AU - Valera Melé,Marc AU - Casitas Hernando,Vicente AU - Poveda,Jose Manuel Hernández AU - Fernández Carballal,Carlos SN - 25298496 M3 - 10.1016/j.neucie.2020.08.002 DO - 10.1016/j.neucie.2020.08.002 UR - https://revistaneurocirugia.com/en-drezotomy-in-treatment-deafferentation-pain-articulo-S2529849620300319 AB - Background and objectivesThe treatment of deafferentation pain by spinal DREZotomy is a proven therapeutic option in the literature. In recent years, use of DREZotomy has been relegated to second place due to the emergence of neuromodulation therapies. The objectives of this study are to demonstrate that DREZotomy continues to be an effective and safe treatment and to analyse predictive factors for success. Patients and methodsA retrospective study was conducted of all patients treated in our department with spinal DREZotomy from 1998 to 2018. Bulbar DREZotomy procedures were excluded. A visual analogue scale (VAS) and the reduction of routine medication were used as outcome variables. Demographic, clinical and operative variables were analysed as predictive factors for success. ResultsA total of 27 patients (51.9% female) with a mean age of 53.7 years underwent DREZotomy. The main cause of pain was brachial plexus injury (BPI) (55.6%) followed by neoplasms (18.5%). The mean time of pain evolution was 8.4 years with a mean intensity of 8.7 according to the VAS, even though 63% of the patients had previously received neurostimulation therapy. Favourable outcome (≥50% pain reduction in the VAS) was observed in 77.8% of patients during the postoperative period and remained in 59.3% of patients after 22 months average follow-up (mean reduction of 4.9 points). This allowed for a reduction in routine analgesic treatment in 70.4% of them. DREZotomy in BPI-related pain presented a significantly higher success rate (93%) than the other pathologies (41.7%) (p = 0.001). No association was observed between outcome and age, gender, DREZ technique, duration of pain or previous neurostimulation therapies. There were six neurological complications, four post-operative transient neurological deficits and two permanent deficits. ConclusionDorsal root entry zone surgery is effective and safe for treating patients with deafferentation pain, especially after brachial plexus injury. It can be considered an alternative treatment after failed neurostimulation techniques for pain control. However, its indication should be considered as the first therapeutic option after medical therapy failure due to its good long-term results. ER -