Dorsal Root Entry Zone (DREZ) Lesioning

Duke Health is the only center in North Carolina, and one of the few in the U.S., offering the DREZ procedure

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Duke Health specialists perform dorsal root entry zone (DREZ) lesioning to reduce chronic, debilitating pain in the shoulder, arm, and hand related to brachial plexus injuries and spinal cord injuries. Our team of neurosurgeons, spine surgeons, neurologists, and others work together to restore your function and improve your quality of life.

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About the DREZ Lesioning Procedure

Dorsal roots carry nerve signals from the extremities to the spinal cord and brain. The area where dorsal roots pass through the outer layer of the spinal cord into the inner layer is called the dorsal root entry zone (DREZ). DREZ lesioning reduces pain in the arm by disconnecting overactive nerve cells that transmit pain signals from damaged dorsal nerve roots. 

Our Location

The DREZ procedure is performed at Duke University Hospital.

DREZ Lesioning Eligibility and Evaluation

You may be eligible for the DREZ procedure if you are experiencing severe shoulder, arm, or hand pain due to a brachial plexus or spinal cord injury despite trying other treatments. Doctors will also consider your overall health, the type and severity of your injury, and your unique anatomy. They may request an MRI or CT scan or a myelogram to inspect your spine in detail and evaluate its strength and stability.

If your injury involves the upper spine, neurosurgeons and spine surgeons may collaborate to perform spine stabilization or spinal fusion at the same time as your DREZ procedure.

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DREZ Lesioning Steps

After you are prepped for surgery and receive general anesthesia, surgeons will perform the following steps during the DREZ procedure, which typically lasts between five to seven hours (it may be longer if spine surgery is performed simultaneously). Throughout the operation, experts use advanced intraoperative neuromonitoring tools to protect important nerves and ensure the procedure is safe and effective.

  1. Surgeons create an opening to the spine and spinal cord (doctors call this a laminotomy or laminectomy). 
  2. They open the dura, a membrane that covers the spinal cord, and find the injured nerve roots and the closest intact nerve root.
  3. Using radiofrequency energy to create heat or using tiny cuts, surgeons create dozens of lesions about one millimeter apart. This breaks connections to overactive nerve cells, silencing their pain signals.

Recovering After DREZ Lesioning

It’s common to feel uncoordinated or unsteady for a few days after the DREZ procedure. You will remain in the hospital for about a week, and you must avoid bending, lifting, or twisting for several months. Because it takes time for the nervous system to adjust, it may be weeks or months before you notice reduced pain. Your doctors will recommend physical therapy to help you build strength and speed recovery.

Best Hospital for Neurology, Neurosurgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our neurology and neurosurgery program is nationally ranked, and the highest-ranked program in North Carolina by U.S. News & World Report for 2023–2024.

Why Choose Duke

Team Approach to Care
Because DREZ lesioning involves the nerves, spine, and arm, your care team may include neurosurgeons, spine surgeons, neurologists, neuromonitoring experts, physical therapists, pain medicine specialists, and others. We combine our expertise to ensure you achieve the best-possible outcome.

Innovative, Experienced Specialists
The DREZ procedure was pioneered at Duke in the 1970s. We continue to be a destination center for people across the country seeking this treatment for chronic pain in the shoulder, arm, and hand related to brachial plexus injuries and spinal cord injuries. Our surgeons are specially trained and highly experienced, performing dozens of DREZ procedures each year. 

Operating Room Technology
Our ORs are equipped with real-time imaging options that give surgeons detailed, 3D images of your spine. OR staff also use a sophisticated sensor navigation system to avoid vital nerves and other structures. This allows for advanced surgical accuracy.

This page was medically reviewed on 07/06/2023 by