Micro-DREZ for Nerve Pain Treatment
A 35 year old gentleman presented to my clinic with his right hand in a sling. He was in obvious anguish. With his face gnarled in pain he told me his story: He had slipped from his bike 6 months back on his right shoulder. Immediately after the injury, he could not move the whole of his right upper limb and had been rushed to a nearby hospital where doctors had told him that he had injured his nerves and had what is technically called a brachial plexus injury.
Within a month of his injury he started having pain in the whole of the right hand up to the elbow which became unbearable over another week. He had consulted various doctors and tried various remedies but to no avail. Unable to bear the pain, he had even attempted suicide thrice without success and he had come to AIIMS as his last hope.
I examined his right hand and there was no power in the whole of the limb. He clearly had nerve pain (Brachial neuralgia). I offered him a surgical procedure, micro-DREZ(microscopic dorsal root entry zone ablation) which had been recently started at AIIMS, Delhi.
He told me that there is nothing to lose and agreed for the surgery. The surgery consists of giving an incision in the neck in the cervical spinal cord along the DREZ and destroy the pain pathways and the procedure last 2 hours. In the postoperative period, I asked the patient if there was relief of pain and the answer I got was NO. I was very surprised and felt that the procedure had let me down. However I took it as a learning curve. Next day on rounds when we asked him about pain, he said that it had completely disappeared! He further elaborated the pain had indeed disappeared following surgery, but his mind was not ready to accept this and hence the delay in announcing to the world! He continues to be completely pain free to this day.
Micro- DREZ is practiced only in few centers in India and this should further ramped up. The procedure itself is simple and only limiting factor is the surgeons expertise. In our series of 15 patients done over last 1 year, more than 95% remain to be completely pain free till date.