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Factors affecting long-term outcome in dorsal root entry zone lesioning for brachial plexus avulsion

Dorsal root entry zone (DREZ) lesioning is a classical and effective treatment for brachial plexus avulsion (BPA). However, because of a limited number of cases reported in the literature, the factors affecting surgical outcomes are not known. Furthermore, whether this ablative procedure in the spin...

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Autores principales: Du, Tao, Ji, Fan, Ni, Bing, Liu, Ruicun, Shu, Wei, Zhang, Xiaohua, Zhu, Hongwei, Tao, Wei, Hu, Yongsheng, Li, Yongjie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10108586/
https://www.ncbi.nlm.nih.gov/pubmed/36156530
http://dx.doi.org/10.1097/j.pain.0000000000002788
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author Du, Tao
Ji, Fan
Ni, Bing
Liu, Ruicun
Shu, Wei
Zhang, Xiaohua
Zhu, Hongwei
Tao, Wei
Hu, Yongsheng
Li, Yongjie
author_facet Du, Tao
Ji, Fan
Ni, Bing
Liu, Ruicun
Shu, Wei
Zhang, Xiaohua
Zhu, Hongwei
Tao, Wei
Hu, Yongsheng
Li, Yongjie
author_sort Du, Tao
collection PubMed
description Dorsal root entry zone (DREZ) lesioning is a classical and effective treatment for brachial plexus avulsion (BPA). However, because of a limited number of cases reported in the literature, the factors affecting surgical outcomes are not known. Furthermore, whether this ablative procedure in the spinal level can change the status of phantom limb pain (PLP) and phantom limb sensation (PLS) is unknown. We retrospectively reviewed the patients with preganglionic BPA who underwent DREZ lesioning at a single center. Patients' baseline characteristics and long-term pain and complications were collected. Postoperative changes in PLP and PLS were recorded. Kaplan–Meier analysis was used to evaluate pain-free survival. Multivariate Cox regression analysis was performed to identify factors affecting pain outcomes. A total of 112 patients met the study inclusion criteria. With an average (range) follow-up of 47.4 (10-134) months, the long-term effectiveness and complication rate were 82.1% and 25.9%, respectively. Of 37 patients (33.0%) who developed PLS, 67.6% (25/37) experienced pain relief, whereas in 45.9% (17/37), PLS disappeared or changed after DREZ lesioning. Multivariate analysis showed that patients with shorter pain duration (≤5 years) and PLS had worse pain outcomes. This study revealed factors that predict the pain outcome of DREZ lesioning based on a large series of cases. The diverse postoperative changes in phantom limb indicate that the mechanisms underlying PLS and PLP at the spinal or supraspinal level may vary among patients with BPA. Future studies should investigate the contribution of maladaptive brain plasticity to the outcomes of patients undergoing DREZ lesioning.
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spelling pubmed-101085862023-04-18 Factors affecting long-term outcome in dorsal root entry zone lesioning for brachial plexus avulsion Du, Tao Ji, Fan Ni, Bing Liu, Ruicun Shu, Wei Zhang, Xiaohua Zhu, Hongwei Tao, Wei Hu, Yongsheng Li, Yongjie Pain Research Paper Dorsal root entry zone (DREZ) lesioning is a classical and effective treatment for brachial plexus avulsion (BPA). However, because of a limited number of cases reported in the literature, the factors affecting surgical outcomes are not known. Furthermore, whether this ablative procedure in the spinal level can change the status of phantom limb pain (PLP) and phantom limb sensation (PLS) is unknown. We retrospectively reviewed the patients with preganglionic BPA who underwent DREZ lesioning at a single center. Patients' baseline characteristics and long-term pain and complications were collected. Postoperative changes in PLP and PLS were recorded. Kaplan–Meier analysis was used to evaluate pain-free survival. Multivariate Cox regression analysis was performed to identify factors affecting pain outcomes. A total of 112 patients met the study inclusion criteria. With an average (range) follow-up of 47.4 (10-134) months, the long-term effectiveness and complication rate were 82.1% and 25.9%, respectively. Of 37 patients (33.0%) who developed PLS, 67.6% (25/37) experienced pain relief, whereas in 45.9% (17/37), PLS disappeared or changed after DREZ lesioning. Multivariate analysis showed that patients with shorter pain duration (≤5 years) and PLS had worse pain outcomes. This study revealed factors that predict the pain outcome of DREZ lesioning based on a large series of cases. The diverse postoperative changes in phantom limb indicate that the mechanisms underlying PLS and PLP at the spinal or supraspinal level may vary among patients with BPA. Future studies should investigate the contribution of maladaptive brain plasticity to the outcomes of patients undergoing DREZ lesioning. Wolters Kluwer 2023-05 2022-09-23 /pmc/articles/PMC10108586/ /pubmed/36156530 http://dx.doi.org/10.1097/j.pain.0000000000002788 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Research Paper
Du, Tao
Ji, Fan
Ni, Bing
Liu, Ruicun
Shu, Wei
Zhang, Xiaohua
Zhu, Hongwei
Tao, Wei
Hu, Yongsheng
Li, Yongjie
Factors affecting long-term outcome in dorsal root entry zone lesioning for brachial plexus avulsion
title Factors affecting long-term outcome in dorsal root entry zone lesioning for brachial plexus avulsion
title_full Factors affecting long-term outcome in dorsal root entry zone lesioning for brachial plexus avulsion
title_fullStr Factors affecting long-term outcome in dorsal root entry zone lesioning for brachial plexus avulsion
title_full_unstemmed Factors affecting long-term outcome in dorsal root entry zone lesioning for brachial plexus avulsion
title_short Factors affecting long-term outcome in dorsal root entry zone lesioning for brachial plexus avulsion
title_sort factors affecting long-term outcome in dorsal root entry zone lesioning for brachial plexus avulsion
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10108586/
https://www.ncbi.nlm.nih.gov/pubmed/36156530
http://dx.doi.org/10.1097/j.pain.0000000000002788
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