A reproducible deep dorsal root entry zone lesioning technique for cervical root avulsion: Outcomes from a clinical series

Background: Neuropathic pain following traumatic cervical root avulsion remains a major clinical challenge when conservative therapies fail. Ablative neurosurgical procedures such as dorsal root entry zone (DREZ) lesioning continue to play a role in this refractory population. We present our experience with a standardized, reproducible microsurgical deep DREZ technique and compare outcomes with those reported in the literature. Methods: We conducted a retrospective series of six patients with intractable neuropathic pain due to root avulsion, treated between 2021 and 2025 at a tertiary referral center in Southern Brazil. All surgeries were performed microsurgically under intraoperative neurophysiological monitoring. Lesions were made at a fixed depth of 4–5 mm targeting Rexed laminae I–VI. Pre and postoperative pain intensity was assessed using the Visual Analog Scale (VAS); postoperative analgesic use and complications were also recorded. Results were contextualized against published data from both superficial and deep DREZ approaches. Results: Postoperative VAS scores ranged from 0 to 3, corresponding to a 66.7–100% reduction in pain; two patients (33.3%) achieved complete pain abolition. Four patients (66.7%) discontinued analgesic medication entirely. The remaining two patients maintained reduced – but altered – pain patterns compared with baseline. No permanent neurological deficits, cerebrospinal fluid leaks, infections, or autonomic disturbances occurred. One patient had a wound dehiscence that was successfully managed. These outcomes are comparable with modern deep DREZ series and appear superior to those historically reported for superficial techniques. Conclusion: A microsurgical standardized deep DREZ lesioning technique targeting laminae I–VI demonstrates high efficacy, reproducibility, and a favorable safety profile for the management of refractory neuropathic pain after cervical root avulsion. Our findings support the adoption of this reproducible technique in specialized centers, although larger prospective studies are necessary to confirm long-term durability across institutions.