T12 Dorsal Root Ganglion Stimulation to Treat Chronic Low Back Pain: A Case Series

Chapman, Kenneth B.; Groenen, Pauline S.; Patel, Kiran V; Vissers, Kris; Helmond, Noud van

doi:10.1111/ner.13047

Cited by 44 publications

(67 citation statements)

References 52 publications

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“…Dorsal root ganglion stimulation (DRG-S) is a type of neuromodulation which has been shown to be effective in the treatment of complex regional pain syndrome and is showing promise in the treatment of low back pain as well as other pain syndromes. 1 – 3 DRG-S system placement involves placing a lead over the DRG. The DRG-S lead is smaller in size compared to traditional spinal cord stimulation (SCS) leads; relative to SCS leads, DRG-S leads are 30% thinner (1.2 vs 0.9 mm in diameter).…”

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confidence: 99%

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

et al. 2020

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We present 4 cases of dorsal root ganglion stimulation lead fracture. In these cases, the surgical technique involved (1) traversing fascial layers for placement of leads via a Tuohy needle in the upper low back, (2) subcutaneous tunneling from the implantable pulse generator site to the lead puncture site without dissecting below the superficial fascial plane at the puncture site, and (3) connection of the lead/extension with the generator. All fractures occurred adjacent to the original lead puncture site. These cases suggest lead entrapment within the membranous fascial plane, with tension on a thin lead, is a mechanism underlying lead fracture.

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confidence: 99%

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

et al. 2020

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“…Beyond the DPN improvements, the patient’s back pain improved significantly during the DRG-S trial, albeit unilaterally. We previously published a case series demonstrating T12 lead placement efficacy in treating chronic axial back pain [ 2 ]. The fact that the therapeutic improvement with DPN symptoms was observed bilaterally, while the somatic back pain only improved ipsilateral to lead placement, highlights the different means by which DRG-S exerts its effects.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Dorsal Root Ganglion Stimulation Lead Placement With Resolution of Bilateral Lower Extremity Symptoms in Diabetic Peripheral Neuropathy

Chapman¹,

Roosendaal²,

Helmond³

et al. 2020

Cureus

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Dorsal root ganglion stimulation (DRG-S) is a form of neuromodulation that can target specific dermatomes to obtain better coverage of the distal extremity. Previously proposed mechanisms of action for DRG-S focused on the dorsal root ganglion (DRG) itself, without consideration of orthodromic effects in the dorsal horn and antidromic effects on the nerve root and sympathetic chain. Diabetic peripheral neuropathy (DPN) is an axonal neuropathy that affects around half of all patients with diabetes mellitus, causing severe pain and sensory impairment in the distal extremities. We present a case of a patient with DPN in both feet, in addition to low back pain, who underwent a DRG-S trial with right T12 and S1 leads. The trial was performed unilaterally for seven days, allowing the patient to compare the treated versus the untreated (left) side. Pain, disability, general health status, and quality of life measures improved significantly. In addition to the significant pain relief in the low back and feet, the patient had near resolution of other DPN-related symptoms, including numbness, bluish discoloration, and allodynia of both feet. He also demonstrated functional and psychological benefits with only a single-sided lead. Overall, the placement of unilateral T12 and S1 DRG-S leads resulted in symmetric improvement of DPN symptoms. A possible mechanism of action is antidromic propagation of action potential signaling into the sympathetic chain to a central ganglion and then to the contralateral sympathetic chain. Given the DRG's ability to directly affect afferent sympathetic fibers with low-frequency stimulation, DRG-S may be an effective neuromodulatory treatment for DPN.

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“…Research supporting the efficacy and safety of DRG‐S for treatment of chronic pain syndromes continues to grow . Many patients with chronic pain conditions have had prior surgical interventions on the spine, and a substantial subset of patients may present with postsurgical changes in anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison, when the lead is placed in a retrograde position, the lead might migrate in a cephalad direction. When permanently implanting upper lumbar/lower thoracic leads, we anchor leads to the fascia to avoid migration . Furthermore, all patients should have a psychological clearance completed prior to their trials, which was done in each of the cases described in this report.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Transgrade Dorsal Root Ganglion Stimulation Lead Placement in Patients with Post‐Surgical Anatomical Changes: A Technical Note

et al. 2019

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Background Stimulation of the dorsal root ganglion (DRG‐S) has been shown to be an efficacious treatment option for refractory neuropathic pain syndromes. However, placement of the percutaneous leads for trial implantation can be challenging in patients with prior spinal surgical interventions resulting in anatomical changes and adhesions. Methods This technical report describes the transgrade placement of DRG‐S leads in 4 patients with back pain surgery histories in whom secondary to specific anatomical pathologies the traditional anterograde placement of DRG‐S leads was not feasible. Results We used a transgrade placement approach, entering superior and contralateral to the target level of placement, resulting in uncomplicated and effective placement of DRG‐S leads. Conclusions Transgrade lead placement for DRG‐S may be an efficacious alternative to traditional anterograde DRG lead placement in cases where interlaminar access below the level of the DRG is not available, or desirable. Further studies are needed to clarify the safety and applicability of this approach.

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T12 Dorsal Root Ganglion Stimulation to Treat Chronic Low Back Pain: A Case Series

Cited by 44 publications

References 52 publications

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

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

Unilateral Dorsal Root Ganglion Stimulation Lead Placement With Resolution of Bilateral Lower Extremity Symptoms in Diabetic Peripheral Neuropathy

Lumbar Transgrade Dorsal Root Ganglion Stimulation Lead Placement in Patients with Post‐Surgical Anatomical Changes: A Technical Note

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