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Factors affecting long-term outcome in dorsal root entry zone lesioning for brachial plexus avulsion

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机构: [1]Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University. [2]Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University.
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Dorsal root entry zone (DREZ) lesioning is a classical and effective treatment for brachial plexus avulsion (BPA). However, because of a limited number of cases reported in the literature, the factors affecting surgical outcomes are not known. Furthermore, whether this ablative procedure in spinal level can change the status of phantom limb pain (PLP) and phantom limb sensation (PLS) is unknown. We retrospectively reviewed the patients with preganglionic BPA who underwent DREZ lesioning at a single center. Patients' baseline characteristics and long-term pain and complications were collected. Postoperative changes in PLP and PLS were recorded. Kaplan-Meier analysis was used to evaluate pain-free survival. Multivariate Cox regression analysis was performed to identify factors affecting pain outcomes. A total of 112 patients met the study inclusion criteria. With an average (range) follow-up of 47.4 (10-134) months, the long-term effectiveness and complication rate were 82.1% and 25.9%, respectively. Of 37 patients (33.0%) who developed PLS, 67.6% (25/37) experienced pain relief whereas in 45.9% (17/37), PLS disappeared or changed after DREZ lesioning. Multivariate analysis showed that patients with shorter pain duration (≤5 years) and PLS had worse pain outcomes. This study revealed factors that predict the pain outcome of DREZ lesioning based on a large series of cases. The diverse postoperative changes in phantom limb indicate that the mechanisms underlying PLS and PLP at the spinal or supraspinal level may vary among patients with BPA. Future studies should investigate the contribution of maladaptive brain plasticity to the outcomes of patients undergoing DREZ lesioning.Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain.

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出版当年[2022]版:
大类 | 1 区 医学
小类 | 1 区 神经科学 1 区 临床神经病学 2 区 麻醉学
最新[2023]版:
大类 | 1 区 医学
小类 | 1 区 临床神经病学 1 区 神经科学 2 区 麻醉学
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出版当年[2021]版:
Q1 ANESTHESIOLOGY Q1 CLINICAL NEUROLOGY Q1 NEUROSCIENCES
最新[2023]版:
Q1 CLINICAL NEUROLOGY Q1 NEUROSCIENCES Q1 ANESTHESIOLOGY

影响因子: 最新[2023版] 最新五年平均 出版当年[2021版] 出版当年五年平均 出版前一年[2020版] 出版后一年[2022版]

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第一作者机构: [1]Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University.
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通讯机构: [1]Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University. [2]Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University. [*1]Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University 45 Chang Chun St, Beijing
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