Spinal Cord Stimulation for Neuropathic Pain Treatment in Brachial Plexus Avulsions: A Literature Review and Report of Two Cases

Success with dorsal root entry zone lesioning after a failed trial of spinal cord stimulation in a patient with pain due to brachial plexus avulsion

“…It has been suggested that the pain relief threshold required for implantation in patients with BP should be lowered to less than 50%. 13 This change would account for the severe, refractory pain usually associated with BP and would be more aligned with clinically significant changes in pain scores for this population. Our patient would have been offered implantation with this adjustment.…”

“…Multiple reports have described substantial pain relief in patients with preganglionic BP using cervical SCS. 13 One study found initial success with conventional SCS followed by loss of efficacy; however, pain relief was rescued by switching to high-frequency (10 kHz) SCS at C2/3. 17 We placed a single electrode at C5 because of the patient's unfavorable anatomy (Fig.…”

“…28,30 However, recent publications reported substantial pain relief with cervical SCS, possibly due to improved stimulation devices and novel waveforms. 13 In patients with severe pain and weakness, dorsal root entry zone (DREZ) lesioning is recommended, although many patients are hesitant to proceed because of the associated morbidity intrinsic to the ablative nature of the procedure. 1,29 Here, we present a patient with preganglionic BP caused by trauma who failed medications and a trial of cervical SCS but responded to DREZ lesioning.…”

The painful shoulder arthroplasty: appropriate work-up and review of interventional pain treatments

“…75 Other publications have described SCS for chronic neck and upper extremity pain, but whether any of these patients had prior TSA or RSA is not reported, and it does not appear that shoulder pain was the primary pain complaint. 1,15,17,20,37 Dorsal root ganglion stimulation Dorsal root ganglion (DRG) stimulation involves targeted stimulation at specific neuroforaminal levels to target the DRG at that location. In doing so, there is enhancement of the T-junction within the DRG, which increases pain signal filtering and decreases pain transmission.…”

The Team Approach to Spinal Cord and Dorsal Root Ganglion Stimulation: A Guide for the Advanced Practice Provider

“… 6 However, SCS and DRGS have been proven effective for pain syndromes beyond the typical indications and should be considered for any patient who has failed to respond to conservative options and would otherwise be an appropriate stimulation candidate. 8 , 9 , 10 , 11 Proper inspection of the surgical site to evaluate for any signs of skin infection or skin breakdown is recommended.…”