Complications

Complications related to DREZ lesioning fall into two major categories: underlesioning and overlesioning. Underlesioning is a problem that continues to be addressed and, with continued improvement in the electrodes and RF lesion generator, are decreasing in frequency.

Overlesioning, on the other hand, can have serious consequences, especially in the case of the spinal cord DREZ lesion. Complications of over-lesioning range from sensory deficits to severe motor deficits, including paraplegia and death. Sensory and motor deficits are often not the result of imprecise anatomical placement of the electrode, but rather from scattering effects from the thermal injury itself. For this reason, special attention should be given to the impedance measurements intraoperatively, and the use of SSEPs during DREZ lesioning is imperative. Other common complications include infection, syrinx formation, limb ataxia, and weakness.

One reason for the failure of a DREZ lesion to be permanent may be the ability of sensory axons to regenerate after injury. The peripheral nervous system (PNS)/CNS junction, as found in the dorsal root entry zone, is especially supportive to axonal regeneration. In fact, the tendency of DREZ lesions to be temporary rather than incomplete may be the result of the temporal ability of sensory neurons to regenerate their axons and reestablish appropriate connections. In other words, DREZ lesions, when technically adequate, often produce complete relief of pain, indicating sufficient disruption of peripheral sensory input as well as the disruption of the neurons responsible for the relaying of nociceptive input to higher centers. However, with the return of pain at some later date, the regeneration of sensory axons and their subsequent re-establishment with nocieptors is likely.

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