According to information from the hospital, Mr. NVT (56 years old, residing in Ho Chi Minh City) came to the Chronic Pain Clinic - Neurosurgery Department, University Medical Center of Ho Chi Minh City (UMC Hospital) for examination with symptoms of pain, numbness, and stiffness throughout his right shoulder, arm, and hand. Mr. T. stated that he had been experiencing persistent and increasingly severe pain since a traffic accident 18 years ago.
He was involved in a traffic accident and his right arm is paralyzed.
Previously, after a traffic accident, Mr. T. was completely paralyzed in his right arm, initially depending entirely on his family for daily activities and eating. He then diligently practiced and regained the ability to move his left arm. However, after only 5-6 months, pain and numbness appeared, along with stiffness throughout his shoulder, arm, and hand. The pain became constant, increasing in intensity and frequency. Mr. T. sought treatment in many places using various methods. Initially, the pain subsided, but it became increasingly severe, forcing him to increase his pain medication dosage to the maximum allowed.
The patient's pain medication dosage is being gradually reduced, and they will continue to have regular follow-up appointments.
In May 2021, Mr. T. visited the Chronic Pain Clinic - Neurosurgery Department of the University of Medicine and Pharmacy Hospital in Ho Chi Minh City, experiencing severe pain with a pain score of 9/10. Doctors diagnosed him with chronic neuropathic pain due to sequelae of right brachial plexus injury and promptly consulted with experienced specialists from Singapore and Thailand.
Following a consultation, the patient was prescribed spinal cord stimulation (SCS) to treat the pain. This procedure requires multiple steps to assess the patient's response to the stimulation.
Following the experimental electrode implantation surgery, the patient experienced over 50% pain relief. Subsequently, doctors proceeded to implant permanent electrodes in the cervical epidural space to control pain and spasticity. The surgery was successful, and within the first year, the patient responded well to treatment, no longer suffering from the "excruciating pain" experienced previously, with an average pain score of 4-5 on a scale of 10.
However, as the disease progressed, the pain became increasingly difficult to control. Doctors continued to consult and manage the patient's pain with morphine, rTMS, Scrambler, etc., but without success.
Applying new techniques , pain treatment is more effective.
To treat patients, in December 2023, doctors in the Neurosurgery Department of the University of Medicine and Pharmacy Hospital in Ho Chi Minh City decided to implement the "DREZotomy" technique to reduce pain.
Associate Professor, Doctor Nguyen Minh Anh, Head of the Neurosurgery Department, stated that "DREZotomy" is a technique that disrupts pain conduction pathways at the level of the posterior horn of the spinal cord, where it enters the sensory nerve roots, altering the spinal reflex arc to reduce pain and spasticity. This is a difficult technique requiring experience, precision, and intraoperative electrophysiological monitoring (IOM). This technique is effective in treating and controlling neuropathic pain and spasticity when other treatments have failed, such as: pain after brachial plexus injury, post-herpetic neuralgia, spinal cord injury, and cancer pain.
After receiving detailed consultation from the doctor, the patient underwent a multidisciplinary consultation and necessary tests. With the coordination of multiple teams, the surgery proceeded smoothly in 2.5 hours. The patient's post-operative condition stabilized, and they were discharged after 2 days.
According to Dr. Do Trong Phuoc, Department of Neurosurgery, University Medical Center of Ho Chi Minh City, immediately after surgery, the patient's pain decreased by 70-80%, the pain score was 3/10, and there was almost no more muscle spasms in the arm, only pain at the surgical site. At the first follow-up visit one month after surgery, the post-operative condition was stable, the wound was dry and healing well, and there were almost no more arm spasms. The patient's sleep improved significantly. The patient's spirits became increasingly optimistic, their appetite improved, and they gained 2 kg.
Currently, three months after his DREZotomy surgery, Mr. T. is having his pain medication dosage gradually reduced and is continuing with regular follow-up appointments so that doctors can monitor and assess the effectiveness of the treatment.
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