Dorsal Root Entry Zone (DREZ) Lesioning

Dorsal roots carry nerve signals from the extremities to the spinal cord and brain. The area where dorsal roots pass through the outer layer of the spinal cord into the inner layer is called the dorsal root entry zone (DREZ). DREZ lesioning reduces pain in the arm by disconnecting overactive nerve cells that transmit pain signals from damaged dorsal nerve roots. 

You may be eligible for the DREZ procedure if you are experiencing severe shoulder, arm, or hand pain due to a brachial plexus or spinal cord injury despite trying other treatments. Doctors will also consider your overall health, the type and severity of your injury, and your unique anatomy. They may request an MRI or CT scan or a myelogram to inspect your spine in detail and evaluate its strength and stability.

If your injury involves the upper spine, neurosurgeons and spine surgeons may collaborate to perform spine stabilization or spinal fusion at the same time as your DREZ procedure.

After you are prepped for surgery and receive general anesthesia, surgeons will perform the following steps during the DREZ procedure, which typically lasts between five to seven hours (it may be longer if spine surgery is performed simultaneously). Throughout the operation, experts use advanced intraoperative neuromonitoring tools to protect important nerves and ensure the procedure is safe and effective.

1. Surgeons create an opening to the spine and spinal cord (doctors call this a laminotomy or laminectomy). 
2. They open the dura, a membrane that covers the spinal cord, and find the injured nerve roots and the closest intact nerve root.
3. Using radiofrequency energy to create heat or using tiny cuts, surgeons create dozens of lesions about one millimeter apart. This breaks connections to overactive nerve cells, silencing their pain signals.

It’s common to feel uncoordinated or unsteady for a few days after the DREZ procedure. You will remain in the hospital for about a week, and you must avoid bending, lifting, or twisting for several months. Because it takes time for the nervous system to adjust, it may be weeks or months before you notice reduced pain. Your doctors will recommend physical therapy to help you build strength and speed recovery.

Team Approach to Care
Because DREZ lesioning involves the nerves, spine, and arm, your care team may include neurosurgeons, spine surgeons, neurologists, neuromonitoring experts, physical therapists, pain medicine specialists, and others. We combine our expertise to ensure you achieve the best-possible outcome.

Innovative, Experienced Specialists
The DREZ procedure was pioneered at Duke in the 1970s. We continue to be a destination center for people across the country seeking this treatment for chronic pain in the shoulder, arm, and hand related to brachial plexus injuries and spinal cord injuries. Our surgeons are specially trained and highly experienced, performing dozens of DREZ procedures each year. 

Operating Room Technology
Our ORs are equipped with real-time imaging options that give surgeons detailed, 3D images of your spine. OR staff also use a sophisticated sensor navigation system to avoid vital nerves and other structures. This allows for advanced surgical accuracy.