Dorsal Root Entry Zone (DREZ) Lesioning
Dorsal root entry zone (DREZ) lesioning is a type of surgery for nerve pain that is used when conservative treatments have not alleviated the patient’s symptoms. This surgery destroys the area where damaged nerves join the central nervous system. This intercepts pain messages from nerves to the brain. DREZ lesioning is particularly beneficial to patients suffering from brachial plexus avulsion, sacral plexus avulsion, or spinal cord injury.
The place where the body’s sensory nerve fibers enter the spinal cord is called the dorsal root. It is through the dorsal root that the nerve fibers send the brain messages about sensations such as touch, temperature, and pain. After an injury to the sensory nerves, changes take place that cause abnormal pain sensations. In patients with these types of nerve injuries, the best treatment for their pain is to destroy the abnormally active cells.
During a DREZ lesioning, UPMC neurosurgeons create an opening in the spine and expose the spinal cord, a procedure called a laminectomy. The surgeon uses a surgical microscope to pass a small probe to the nerve cells that trigger the pain messages, which are then destroyed using a radiofrequency current. This process is repeated at intervals along the spinal cord in the areas where the pain originates. Most patients experience relief of pain immediately after surgery and sustain good pain relief over the long term.