Drezotomy In Management Of Post-Traumatic Brachial Plexus Root Avulsion Neuropathic Pain: A Case In A Resource-Limited Setting In Abidjan

Abstract

Introduction: Patients with brachial plexus avulsion frequently suffer from chronic intractable neuropathic pain resulting from preganglionic disruption of the spinal cord's nerve root. Traumatic traction, followed by compression, represents the leading cause. Avulsion associates injury of components of the spinal cord Lissauer track (LT), posterior horn of spinal cord (PHSC), and dorsolateral fasciculus, resulting in complex pain pathophysiology managed by either neuromodulation or neuroablative surgery, most used being dorsal root entry zone lesioning (DREZotomy). We present a case of successful pain relief after DREZotomy post traumatic brachial plexus avulsion. Clinical case: 30 years right-handed male student with a 2 years history of chronic transient pain rated at 10/10 following C5 to C8 dermatome associated with numbness. On Physical examination, the pain was DN4 quoted with deltoid muscle amyotrophy and motor deficit of the corresponding myotome. Imaging highlighted left partial brachial plexus avulsion. After careful MRI analysis, we opted for DREZotomy, though the absence of sophisticated apparatus such as evoked potential. A marked decline of pain from 10 to 1 post-op. A good evolution was observed to date, with a complete return to day-to-day activities. Conclusion: Brachial plexus avulsion represents an invalidating injury with management requiring sophisticated instruments, rare in Low and Middle-Income (LMI) settings. However, meticulous study of imaging anatomy could help administer neuroablative treatment to improve the patient's quality of life. Nevertheless, ideally, the aid of these instruments for such delicate surgery should be a must but remain a luxury challenging to afford.