Dorsal Root Entry Zone Lesioning: Systematic Review

Abstract

Introduction Dorsal root entry zone (DREZ) leasioning (DREZ-otomy) is considered an effective treatment for chronic pain due to spinal cord injuries, brachial and lumbosacral plexus injuries, postherpetic neuralgia, spasticity, and other conditions. The objective of the technique is to cause a selective destruction of the afferent pain fibers located in the dorsal region of the spinal cord.

Objective To identify and review the effectiveness and the main aspects related to DREZ-otomy, as well as the etiologies that can be treated with it.

Methods The PubMed, MEDLINE and LILACS databases were used as bases for this systematic review, having the impact factor as the selection criteria. The 23 selected publications, totalizing 1,099 patients, were organized in a table for systematic analysis.

Results Satisfactory pain control was observed in 70.1% of the cases, with the best results being found in patients with brachial/lumbosacral plexus injury (70.8%) and the worst, in patients with trigeminal pain (40% to 67%).

Discussion Most of the published articles observed excellent results in the control of chronic pain, especially in cases of plexus injuries. Complications are rare, and can be minimized with the use of new technologies for intraoperative monitoring and imaging.

Conclusion DREZ-otomy can be considered a great alternative for the treatment of chronic pain, especially in patients who do not tolerate the side effects of the medications used in the clinical management or have refractory pain.

Resumo

Introdução O lesionamento da zona de entrada da raiz dorsal (dorsal root entry zone, DREZ), ou DREZ-otomia, é considerado um tratamento eficaz para a dor crônica decorrente de lesões medulares, lesão dos plexos braquial e lombossacro, neuralgia pós-herpética, espasticidade, entre outras lesões. O objetivo da técnica é causar uma destruição seletiva das fibras localizadas na região dorsal da medula espinal, entre elas as fibras aferentes de dor.

Objetivo Identificar a efetividade da DREZ-otomia e as principais etiologias que podem ser tratadas por este procedimento, e revisar os principais aspectos relacionados à técnica.

Métodos As bases de dados do PubMed, MEDLINE e Lilacs foram utilizadas na realização desta revisão sistemática, tendo o impacto como critério de seleção. As 23 publicações selecionadas, totalizando 1.099 pacientes, foram organizadas numa tabela para análise sistemática.

Resultados Controle satisfatório da dor foi observado em 70,1% dos casos, sendo que os melhores resultados foram encontrados em pacientes com lesão dos plexos braquial/lombossacro (70,8%), e os piores, em pacientes com dor neuropática do nervo trigêmeo (40% a 67%).

Discussão A maioria dos artigos publicados encontrou ótimos resultados no controle da dor crônica, principalmente na dor relacionada à lesão de plexos. As complicações são raras, podendo ser minimizadas com o emprego das novas tecnologias de monitoração intraoperatória e imagem existentes.

Conclusão A drezotomia pode ser considerada uma ótima alternativa para o tratamento da dor crônica, especialmente em pacientes que não toleram os efeitos colaterais das medicações utilizadas no manejo clínico ou apresentam dor refratária.

Keywords

neuropathic pain - dorsal root entry zone - radiculopathy - spinal cord

Palavras-chave

dor neuropática - zona de entrada da raiz dorsal - radiculopatia - medula espinal

Publikationsverlauf

Eingereicht: 04. Mai 2020

Angenommen: 24. August 2020

Artikel online veröffentlicht:
26. November 2020

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