Results of dorsal root entry zone (DREZ) lesioning for central neuropathic pain due to traumatic spinal cord injuries

To review the efficacy and safety of the Lissauer's tract and the dorsal horn of the spinal cord lesion in the treatment of neuropathic pain after traumatic spinal cord injury. Central neuropathic pain has a major impact on the quality of life for many patients with traumatic spinal cord injury. Lesion in the dorsal root entry zone has become one of the various treatment options. Only primary studies of patients with more than 13 years old, who presented traumatic spinal cord injury and central neuropathic pain, receiving dorsal root entry zone lesioning were included. Among the included studies, all were case series ranging from 5 to 54 patients. According to the results, at least 50% of patients achieved more than 50% of pain relief or experienced no pain limitation for activity, without the need for opioids. However, all studies analyzed had poorly defined eligibility criteria, lack of control groups and inadequate description of adverse effects and complications. The studies reviewed indicate promising results with the dorsal root entry zone lesioning for the treatment of central neuropathic pain in selected patients with traumatic spinal cord injury. However, the level of evidence provided by the studies is still low, especially in terms of study design, evaluation and analysis of results, description of the severity of adverse effects and patient selection criteria. For these reasons, although there are studies with favorable results with this surgical technique, the level of scientific evidence remains weak.