Dorsal Root Ganglion Stimulation Lead Fracture Within the Superficial Fascial Layers in 4 Cases

Chapman, Kenneth B.; Patel, Kiran V; Helmond, Noud van; Chien, George C. Chang

doi:10.1213/xaa.0000000000001307

Cited by 6 publications

(8 citation statements)

References 17 publications

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“…34 Their approach for placement of the 1.2 mm diameter leads was in the oblique plane with the lead travelling medially through the iliocostalis and multifidus muscles, similar to DRG-S lead placement. Consistent with our previously cited hypothesis, 32 the authors hypothesized that transecting fascial planes played a role in fracture and they modified their technique to take a midline approach, which appeared to improve outcomes. 34 DRG-S leads have an ~ 30% thinner diameter than SCS leads and have been assumed to be less durable, although the test data that was submitted for FDA approval is not necessarily reflective of this.…”

Section: Fracturessupporting

confidence: 72%

“…In unanchored leads, it has previously been hypothesized that a lack of bypassing the superficial fascial plane during tunneling was a potential cause of lead fracture. 32 A tunneled epidural catheter or a superficial stab incision is commonly used to create a point to tunnel the lead and may decrease infection risk and operating room (OR) time. 16 However, not bypassing the superficial fascia may lead to entrapment of the lead in this plane.…”

Section: Fracturesmentioning

confidence: 99%

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Lead migration and fracture rate in dorsal root ganglion stimulation using anchoring and non‐anchoring techniques: A multicenter pooled data analysis

et al. 2021

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Introduction: Dorsal root ganglion stimulation (DRG-S) is a neuromodulation technique introduced in the last decade with evolving implant methods. Initial prospective research found low incidences of lead migration and lead fracture with DRG-S. However, several recent studies have highlighted high lead migration and lead fracture rates with DRG-S. We investigated the influence of lead anchoring on migrations and fractures. Methods:We performed a retrospective review between 2016 and 2020 of individuals implanted with DRG-S leads by 4 experienced implanters. The implanters independently changed their standard practice regarding lead anchoring over time, with opposing trends (no anchoring > anchoring, anchoring > no anchoring). We compared lead migration and lead fracture rates between anchored and unanchored DRG-S leads in the entire study cohort. Cox regression was performed on lead migration and fracture distributions. Results:We included 756 leads (n = 565 anchored and n = 191 unanchored) from 249 patients. In unanchored leads, migration occurred in 16 leads (8.4%) from 13 patients (21.0%). In anchored leads, migration occurred in 8 leads (1.4%) from 5 patients (2.7%). Fracture in unanchored leads occurred in 6 leads (3.1%) from 6 patients (9.7%). Fractures in anchored leads occurred in 11 leads (1.9%) from 9 patients (4.8%). The migration survival distributions for the anchored and unanchored leads were statistically significantly different (p < 0.01) with decreased survival for unanchored leads (hazard ratio = 5.8, 95% confidence interval [CI] = 2.2-15.5). Discussion:We found that anchoring DRG-S leads significantly reduces lead migration when compared to leads placed without an anchor. There was no significant difference in fracture rate between anchored and unanchored leads.

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Section: Fracturessupporting

confidence: 72%

Section: Fracturesmentioning

confidence: 99%

Lead migration and fracture rate in dorsal root ganglion stimulation using anchoring and non‐anchoring techniques: A multicenter pooled data analysis

et al. 2021

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“…The authors hypothesized that these fractures were secondary to traversing the paraspinal muscles and resultant entrapment of the lead in the superficial plane. 176,177 To potentially reduce the risk of lead fracture and migrations, this led to a novel ipsilateral, paramedian approach for DRG-S lead placement and anchoring to be presented. 178 The ipsilateral technique maximizes an entry parallel to the spinous process and avoidance of paraspinal musculature and fascia and is discussed in the following text.…”

Section: Techniquementioning

confidence: 99%

“…The approach to implanting leads using the paramedian approach has been detailed for adjacent level lead placement and bilateral lead placement. 177 When using either this or the traditional contralateral approach, it is vital to anchor leads and dissect to the deep fascia to minimize lead migration and fracture.…”

Section: Ipsilateral Lead Placement Using a Paramedian Approachmentioning

confidence: 99%

Best Practices for Dorsal Root Ganglion Stimulation for Chronic Pain: Guidelines from the American Society of Pain and Neuroscience

Chapman¹,

Sayed²,

Lamer³

et al. 2023

JPR

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With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion stimulation (DRG-S) has significantly improved the treatment of complex regional pain syndrome (CRPS), and it has broad applicability across a wide range of other conditions. Through funding and organizational leadership by the American Society for Pain and Neuroscience (ASPN), this best practices consensus document has been developed for the selection, implantation, and use of DRG stimulation for the treatment of chronic pain syndromes. This document is composed of a comprehensive narrative literature review that has been performed regarding the role of the DRG in chronic pain and the clinical evidence for DRG-S as a treatment for multiple pain etiologies. Best practice recommendations encompass safety management, implantation techniques, and mitigation of the potential complications reported in the literature. Looking to the future of neuromodulation, DRG-S holds promise as a robust intervention for otherwise intractable pain.

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“…A review of complications following DRG surgery cited lead removal as a common complication ( 75 ). Additionally, a case study on 4 patients undergoing DRG for various indications noted lead fracture in all four cases, where 3 of the 4 have undergone previous surgeries ( 76 ). Regardless, DRGS is an area of active study.…”

Section: Dorsal Root Ganglion Stimulationmentioning

confidence: 99%

Spinal Cord Stimulation as Treatment for Cancer and Chemotherapy-Induced Pain

et al. 2021

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Neuropathic pain is a rampant disease exacting a significant toll on patients, providers, and health care systems around the globe. Neuromodulation has been successfully employed to treat many indications including failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), phantom limb pain (PLP), radiculopathies, and intractable pelvic pain, among many others. Recent studies have also demonstrated efficacy for cancer-related pain and chemotherapy induced neuropathy with these techniques. Spinal cord stimulation (SCS) is the most commonly employed technique and involves implantation of percutaneous or paddle leads targeting the dorsal columns of the spinal cord with the goal of disrupting the pain signals traveling to the brain. Tonic, high frequency, and burst waveforms have all been shown to reduce pain and disability in chronic pain patients. Closed-loop SCS systems that automatically adjust stimulation parameters based on feedback (such as evoked compound action potentials) are becoming increasingly used to help ease the burden placed on patients to adjust their programming to their pain and position. Additionally, dorsal root ganglion stimulation (DRGS) is a newer technique that allows for dermatomal coverage especially in patients with pain in up to two dermatomes. Regardless of the technique chosen, neuromodulation has been shown to be cost-effective and efficacious and should be given full consideration in patients with chronic pain conditions.

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Dorsal Root Ganglion Stimulation Lead Fracture Within the Superficial Fascial Layers in 4 Cases

Cited by 6 publications

References 17 publications

Lead migration and fracture rate in dorsal root ganglion stimulation using anchoring and non‐anchoring techniques: A multicenter pooled data analysis

Lead migration and fracture rate in dorsal root ganglion stimulation using anchoring and non‐anchoring techniques: A multicenter pooled data analysis

Best Practices for Dorsal Root Ganglion Stimulation for Chronic Pain: Guidelines from the American Society of Pain and Neuroscience

Spinal Cord Stimulation as Treatment for Cancer and Chemotherapy-Induced Pain

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