Microscissor DREZ is a new technique devised by the author wherein only micro-scissors are used for the whole procedure. This is much more safer, efficacious & cost effective as compared to traditional DREZ and can be used in intractable neuropathic pain and spasticity

1. Micro-DREZ for Brachial
Neuralgia
Dr Deepak Agrawal
Additional Professor, Neurosurgery
AIIMS

2. “Pain is a more
terrible lord
of mankind
than even
death itself”
PAIN
Dr. Albert Schweitzer
(1875-1965)

3. Deafferentation pain
Pain or dysesthesia caused by interruption of the
peripheral or central afferent input in the central
nervous system
Sweet WH. Deafferentation pain in man. Appl Neurophysiol. 1988;51:117–27.
BRACHIAL NEURALGIA

4.  More than 500 patients/ year at AIIMS
itself
 70% will have brachial Neuralgia
BRACHIAL PLEXUS INJURIES

5. Microsurgical DREZ-otomy was introduced in 1972
Anatomical studies of the human dorsal root entry zone (DREZ)
showing a topographical segregation of the afferent fibers
according to their size and functional destinations.
MICROSURGICAL DREZ

6. MICRO DREZ- ANATOMY

7. MICRO DREZ- ANATOMY

9. TYPES OF DREZ

10. DREZ AREA

11. 2 mm deep microsurgical lesion
directed at a 45 degrees angle in
the posterolateral sulcus and
penetrating the dorsal root entry
zone in its ventrolateral aspect, at
the level of all the rootlets
considered involved in spasticity
(and pain)

12. MICRO DREZ
It destroys mainly the lateral
(nociceptive) and central (myotatic)
afferent fibers as well as the
facilitatory medial part of the
Lissauer tract, while sparing most
of the medial (lemniscal) fibers, the
suppressor lateral part of the
Lissauer tract, and more or less of
the dorsal horn (DH).

13. EXPOSURE

14. DREZ SURGERY

16. POSTOP

17. • Excess of spasticity, especially when associated with severe pain (Seen in
post-Stroke patients in in Multiple Sclerosis)
• Well-localized cancer pain, such as Pancoast syndrome
• Neuropathic pain due to: brachial plexus injuries; cauda equina and/or
spinal cord lesions (especially for pain corresponding to segmental lesions);
• Peripheral nerve injuries, amputation, herpes
OTHER INDICATIONS

18. MICROSURGICAL DREZOTOMY

19. • 44 patients of SCI with severe neuropathic pain
•
Follow-up ranged from 1 to 20 years (mean 6 yrs)
• Immediate pain relief was obtained in 70% of patients and
was long-lasting in 60% of the total series.
• Good long-term results were obtained in 68% of the patients
MICROSURGICAL DREZOTOMY

20. • Started doing in March 2014
• Total of 8 cases (Including one for Post traumatic severe UL spasticity)
• All have become pain free
• No new deficits/ morbidity/ mortality
AIIMS SERIES

21. • Is a relatively inexpensive procedure
• Does not require any special equipment
• Should be the preferred treatment in Brachial Neuralgia
• May be also considered for severe spasticity &/or pain in post stroke
patients, SCI patients & pain associated with malignancy
CONCLUSIONS- MICRO DREZ

22. THANK YOU