Spinal cord stimulation (SCS) and dorsal root entry zone (DREZ) lesioning are important therapeutic option for intractable posttraumatic neuropathic pain (PNP). However, surgical choice is controversial due to the need to maximize pain relief and reduce complications. This study aims to retrospectively analyze the effect and complications of DREZ lesioning for PNP patients who were unresponsive to SCS and provide a surgical reference.Demographic data and surgical characteristics of PNP patients who underwent DREZ lesioning following an unresponsive SCS were reviewed. Long-term outcomes including Numeric rating scale (NRS), Global Impression of Change, and long-term complications were assessed. Kaplan-Meier analysis was used to evaluate pain-free survival.Of 19 PNP patients, 8 had brachial plexus injury (BPI), 7 had spinal cord injury, 2 had cauda equina injury, 1 had intercostal nerve injury, and 1 had lumbosacral plexus injury. All patients were unresponsive or had a recurrence of pain following SCS, with an average pain relief rate of 9.3%. After DREZ lesioning, the mean NRS scores significantly decreased from 7.6±1.5 to 1.8±1.7, with an average pain relief rate of 75.3%. Seven patients (36.8%) experienced worsened neurologic dysfunction at last follow-up. Patients with BPI had significant better outcome than other pathologies (P<0.001) after DREZ lesioning.DREZ lesioning is an effective alternative procedure to SCS for PNP patients who have lost limb function. Particularly for those with BPI, DREZ lesioning has shown good efficacy and can be considered a preferred surgical option.Copyright © 2023 Elsevier Inc. All rights reserved.