Dorsal root entry zone lesioning and deep brain stimulation for neuropathic pain
Dorsal root entry zone (DREZ) lesioning involves a neurosurgeon exposing the spinal canal via a laminectomy and inserting a small probe under a microscope to destroy dorsal horn cells of the spinal cord via radiofrequency ablation. The procedure has had promising results in treatment of brachial or sacral plexus avulsion and SCI, but has not been found to be useful in phantom limb pain. Risks include unintentional injury to the spinal cord, which could cause long-term weakness or sensation changes. Deep brain stimulation (DBS) has been used in epilepsy, Tourette syndrome, and psychiatric disorders, as well as chronic pain. It involves placement of electrodes to the ventral posterior lateral and medial thalamic nuclei, or the periventricular grey matter. Long-term results have been mixed, though may be effective for neuropathic pain and phantom limb pain in well-selected patients.