DREZ myelotomy (Dorsal Root Entry Zone Lesioning, DREZ) is a neurosurgical procedure aimed at targeted destruction of the dorsal root entry zone of the spinal cord. The procedure is used to treat severe chronic pain syndromes that are refractory to pharmacological therapy, particularly in patients with traumatic spinal cord injuries or limb amputations.
Indications for DREZ myelotomy
Chronic pain syndromes:
- Post-traumatic pain following spinal cord injury.
- Phantom limb pain after amputation.
- Pain associated with plexopathy (e.g., brachial plexus injury).
- Central post-stroke pain.
Spastic conditions: severe pain-associated spasticity that is resistant to conservative treatment.
Neuropathic pain: persistent neuropathic pain caused by damage to peripheral nerves or the spinal cord.
Advantages of DREZ myelotomy
- Effective pain relief. Eliminates chronic neuropathic pain that does not respond to medication.
- Minimal invasiveness. Use of microsurgical techniques reduces the risk of complications.
- Relatively fast recovery. Most patients return to daily activities within several weeks.
- Improved quality of life. Pain relief allows restoration of mobility and functional activity.
Mechanism of action
The dorsal root entry zone (DREZ) is the area where sensory nerve fibers enter the spinal cord. After trauma or nerve damage, this zone may become a source of pathological hyperexcitability, leading to chronic pain. DREZ myelotomy selectively destroys hyperactive neurons, interrupting the transmission of pain signals.
Preoperative preparation
- Diagnostics: spinal MRI, electromyography (EMG), CT myelography.
- Neurologist consultation to assess pain characteristics; anesthesiology consultation to determine the optimal anesthesia strategy.
- Psychological preparation: discussion of expected outcomes and potential risks with the patient.
Surgical procedure
- Anesthesia. General anesthesia.
- Surgical access. Laminectomy (removal of the vertebral lamina of one or more vertebrae) to expose the spinal cord.
- Identification of the DREZ. The hyperactive area is precisely localized using an operating microscope and/or intraoperative neurophysiological monitoring.
- Lesioning. A microelectrode or laser is used to selectively destroy neurons in the dorsal root entry zone. The lesion is performed in a highly targeted manner to minimize damage to adjacent structures.
- Wound closure. Layer-by-layer closure of tissues and restoration of bony structures when feasible.
Postoperative period
- Pharmacological therapy: analgesics, neuroprotective agents to support surrounding tissues, anticonvulsants when seizure risk is present.
- Rehabilitation. Physiotherapy to restore mobility and therapeutic exercise to strengthen muscles.
- Clinical follow-up: regular neurological examinations to assess treatment effectiveness; follow-up imaging (e.g., MRI) when indicated.
DREZ myelotomy in Belarus is a highly precise surgical method for the treatment of chronic pain syndromes that are resistant to conservative therapy. The use of modern neurosurgical technologies and the extensive experience of specialists ensure high efficacy with a low risk of complications. Timely referral to a neurosurgeon and strict adherence to postoperative recommendations significantly improve patient quality of life.
