After the Crash: The High-Risk Neurosurgery that Brought Astra Peace

One minute, Astra was traveling to Birmingham, Alabama with her husband and their three daughters, cheerfully texting friends to wish them a merry Christmas.

The next, she watched in horror as the family SUV crested a blind hill and encountered a sudden backup. Vehicles in front of them swerved on the slick road surface, and Astra’s husband, Stephen, had almost no time to react. Their SUV began to hydroplane and hurtled toward another SUV and an 18-wheeler that had already come to a stop.

“I thought for a moment that Stephen could squeeze between the vehicles in front of us,” Astra says. “But the gap was too narrow, and we hit the guard bar under the truck’s cargo doors—that long, steel bar that prevents vehicles from sliding underneath in a collision. The bar sheared off the entire passenger side of our SUV—like a can opener.”

After the crash, Stephen jumped out of their mangled SUV and checked on the children before rushing to Astra’s side. Astra remembers that moment vividly. “Stephen realized how horrific my injuries were and screamed for help. Then he looked at me and said, ‘Baby, don’t open your eyes. Don’t look at your arm.’”

The crash severed Astra’s right arm at the elbow. She would learn the full extent of her injuries over the next few days. But in those first moments, Stephen and others scrambled to stop the bleeding from what was left of her arm. Stephen fashioned a tourniquet from a cloth belt someone handed him. About 25 minutes after the crash, Astra was on her way to a hospital in an ambulance. It was December 25, 2023.

A trauma team spent eight hours removing crash debris from Astra’s body. During Astra’s surgery, Stephen was presented with a spreadsheet of his wife’s injuries. “I had fractured my pelvis, both legs and ankles, nine ribs, my neck, sternum, jaw, right eye socket, eight teeth and nose,” says Astra.

What doctors didn’t realize was that Astra had suffered another catastrophic injury they couldn’t see—a brachial plexus avulsion. In the months to follow, this trauma to her peripheral nervous system would cause unremitting, devastating pain, not from her healing bones, but from the arm that was no longer there.

Over the next four days, Astra had six surgeries to repair her broken bones and remained in the hospital for three weeks. She returned home in mid-January to begin the long recovery process, which involved rest, physical therapy and learning to do everything left-handed. Stephen and the kids, Astra’s mom and an army of friends rallied around her, providing round-the-clock care.

Over the next six months, Astra’s bones slowly healed. On Easter Sunday 2024, she could attend church in a wheelchair. Six weeks later, she attended her oldest daughter’s high school graduation. By summer, she was able to drive her car left-handed.

Yet, in quiet moments, Astra wondered if she would ever truly regain her life. The phantom pain was constant—and excruciating.

“Sometimes it felt like my missing forearm was on fire or had been struck by lightning,” says Astra, who is now 46. “Nothing brought relief, and the pain specialist I consulted just wanted to keep prescribing me more medicine. I was already taking 23 pills a day, and most of them were for the pain. I told Stephen, ‘I don’t know how I can live with this pain for the rest of my life.’ Now I understand why people with chronic pain can become desperate for relief.”

A Rare Diagnosis Leads to More Questions than Answers

In November 2024, Astra was ready for answers. She sought out a magnetic resonance imaging (MRI) scan of her spine and amputated right arm—known medically as her “residual arm.” “Stephen and I went to that appointment, excited to hear about the MRI results and new treatment options,” she says. They got the diagnosis—but no clear path toward relief. “I couldn’t believe what I was hearing.”

Astra had a rare and debilitating brachial plexus injury known as a brachial plexus avulsion. The crash had caused severe trauma to the nerve roots in Astra’s brachial plexus—the nerve network that connects the upper spinal cord to the nerves in the arm. All five of Astra’s brachial nerve roots had been ripped out of the spinal cord. In response, her nerves were firing out of control, sending chaotic pain signals to her brain day and night.

Surgery to reattach the nerves to the spine wasn’t an option. Astra was told she had reached the end of the road with her current care team—there was nothing more they could do for her. “They told me there was one doctor who might be able to help and he was at Emory Healthcare,” Astra says. “That’s when I was given Dr. Boulis’s number.”

Emory Brain Health Center delivers personalized care for brain and behavioral conditions by bringing together top specialists across neurology, psychiatry, neurosurgery and rehabilitation. Nicholas Boulis, MD is an Emory Healthcare neurosurgeon who specializes in functional neurosurgery.

Functional neurosurgery focuses on improving or restoring nervous system function in the brain and spinal cord. Dr. Boulis treats people with:

• Craniofacial pain syndromes
• Movement disorders such as Parkinson’s disease
• Peripheral nervous system injuries, including brachial plexus avulsion
• Peripheral nerve tumors
• Severe pain that doesn’t respond to other treatments (severe refractory pain)
• Trigeminal neuralgia, a nerve condition that causes sudden, severe facial pain

Functional neurosurgeons like Dr. Boulis try to pinpoint how disrupted circuits in the nervous system cause problems such as pain and tremors. Then, these specialists counteract the imbalanced signals, either by interrupting the circuit or implanting electrodes to control it.

Astra and Stephen met with Dr. Boulis a few weeks after her appointment with Dr. Zelinski. The three of them discussed her MRI results and pain symptoms. Then, Dr. Boulis told them about the dorsal root entry zone (DREZ) procedure.

DREZ is an eight- to 10-hour surgery that uses a surgical microscope to locate the torn-away nerve roots near the spine. To stop the pain, the surgeon uses an electrode or other device to kill the overactive spinal cord cells with a precise electrode.

DREZ is available at only about 10 medical centers in the country. “The surgery carries high risk because you are destroying damaged spinal cord cells located very close to healthy wires that connect the brain to lower parts of the spinal cord,” Dr. Boulis says. “If you miss, you can cause permanent damage that leads to numbness or weakness.”

In the hands of a skilled, experienced neurosurgeon, however, DREZ can be life-changing. “Most of my patients experience relief—often, significant relief,” Dr. Boulis says. “Our complication rate is very low. DREZ is something I may recommend when patients have tried everything else.”

Dr. Boulis explained the procedure and potential risks to Astra, and she didn’t hesitate. “I had already researched Dr. Boulis’s practice online, and I could tell from talking with him how passionate he is about helping patients,” Astra says. “I booked the surgery before we left his office. There was no doubt this was the next step.

“I was completely confident about the surgery, especially since it would be at Emory,” she adds. “We’re so blessed here in Atlanta to have great hospitals, and Emory is a class above the rest for complex treatments like this.”

Astra’s surgery was on Valentine’s Day, 2025. When she woke up in the intensive care unit the next morning, she felt a difference right away. “It felt like someone had unplugged my arm—the intense, shooting pain was gone,” Astra says. “When Dr. Boulis came to see me in the ICU, I couldn’t stop telling him how amazing he is and how grateful I was for the relief.”

Since her DREZ procedure, Astra has experienced what she calls a total comeback. She can attend her daughter’s school events, watch her 10-year-old play soccer and attend church regularly. She only takes four medicines a day.

And the phantom pain? Almost gone. “What a drastic change! I can still feel some discomfort where my right middle finger used to be, but aside from that one twinge, I feel great,” she says.

Success stories like these motivate Dr. Boulis to continue refining the DREZ procedure through basic and clinical research. He is working with several pharmaceutical companies to develop targeted gene therapy for brachial plexus avulsion. This lower-risk therapy would control the nerve roots instead of burning them.

“That’s what’s great about Emory: we take on challenging problems and develop better approaches,” he says. “We are willing to be very creative and offer solutions for patients when no one else can. We see a better future out there for people with debilitating pain.”

About Emory Neurosurgery

Emory Healthcare's Neurosurgery Services provides expertise and training in both general neurosurgery and specialized areas. Learn more about the wide range of neurosurgery conditions we diagnose, treat and manage or call 404-778-5770.