Notes of: Dr Deepak Agrawal
Additional Professor, Neurosurgery
A 35-year-old patient with his right hand in a sling arrived to the clinic complaining of severe pain. With great difficulty, he narrated the incident from six months ago when he had fallen on his right shoulder while riding a motorbike.
As a result of the accident, he had lost all control on his right upper limb (upper extremity), making him unable to move his hand. He was rushed to a nearby hospital where doctors told him he had injured his nerves and had suffered what is technically called a ‘brachial plexus’ injury.
Within a month of the accident, he began experiencing pain in his right hand all the way up to the elbow; by the next week, the pain had become almost unbearable. Several visits to doctors and various measures were attempted but nothing proved successful. Having lost all hopes and under extreme depression, the patient arrived at AIIMS as his last resort.
Initial examination proved that he had lost movement and energy in the entire limb. He clearly had nerve pain (brachial neuralgia).
A surgical procedure called micro-DREZ (microscopic dorsal root entry zone ablation), which had been recently started at AIIMS, was adopted.
The surgery, the duration of which generally lasts two hours, consists giving an incision on the neck in the cervical spinal cord along with the DREZ that kills the pathways to pain. Post surgery, the patient reported no loss of pain, saying he could still not move his limb.
This was very surprising and it felt as if the procedure was a let-down. In such a case, a doctor can only accept the result and see the incident as a learning curve. Only, it wasn’t so much. The next day on rounds, he said that the pain had completely disappeared. In fact, details recalled in hindsight suggested that he was relieved of his pain soon after the surgery but he admitted that he was not yet ready to believe that it indeed had happened.
Micro-DREZ is practiced only at a few centres in India and this case should ramp up its practice. The procedure is simple in itself with the only factor that may act as a limitation being the surgeon’s expertise. Of the 15 patients that this surgical procedure has been conducted upon in the past one year, 14 of them never reported experiencing any pain to date.
As told to Prashant Dixit