Citations 2
A paramedian approach for dorsal root ganglion stimulation placement developed to limit lead migration and fracture
Chapman, Kenneth B. , Spiegel, Matthew A., Dickerson, David , Billet, Bart , Patel, Kiran V., Hunter, Corey , Antony, Ajay, Helmond, Noud van , Kallewaard, Jan Willem , Yang, Ajax , van Helmond, Noud , Hagedorn, Jonathan M , Dickerson, David M , Deer, Timothy R. , Hagedorn, Jonathan M.
Pain Practice | July 30, 2021 | Volume: 21 | Issue: 8 | Pages: 991-1000
Abstract Introduction Dorsal root ganglion stimulation (DRG‐S), has demonstrated superiority in the treatment of complex regional pain syndrome and causalgia. Lead migration and fracture impact DRG‐S therapeutic stability. Lead anchoring reduces DRG‐S lead migration without increasing lead fracture. Lead fracture may be related to lead entrapment in the superficial fascial plane. A novel medialized approach for lead placement and anchoring is presented to address these issues. Methods We suggest an alternative technique for implanting percutaneous DRG‐S leads at the T10‐L5 levels. Results A novel medialized ipsilateral technique for lead placement and anchoring for single, bilateral, and adjacent segment placement is presented. The Tuohy needle puncture site is medial to the pedicle and adjacent to the spinous process, two vertebral levels caudad to the target foramen. Trajectory is maintained in the sagittal plane, to access the caudad interlaminar space near the midline. This technique allows for ipsilateral or contralateral lead placement. After epidural access, the introducer sheath is rotated toward the targeted foramen and advanced. The guidewire followed by the lead is passed, and once lead position is confirmed, tension “S” loops are created, followed by anchoring to the deep fascia. Conclusion We describe a new paramedian technique for DRG‐S lead placement. We propose it will decrease DRG‐S complication rates through anchoring to reduce migration and by avoiding the fascial planes thought to be responsible for fracture. Long‐term outcomes applying our proposed techniques are required for determining the true impact, however, early anecdotal results suggest that these new techniques are favorable.
A Systematic Literature Review of Dorsal Root Ganglion Neurostimulation for the Treatment of Pain
Hunter, Corey , Grider, Jay S., Lamer, Tim J. , Pope, Jason E. , Falowski, Steven , Esposito, Michael, Baranidharan, Ganesan , Jassal, Navdeep, Mogilner, Alon Y. , Kapural, Leo, Verrills, Paul , Amirdelfan, Kasra , McRoberts, W. Porter , Harned, Michael , Chapman, Kenneth B. , Liem, Liong, Carlson, Jonathan D. , Yang, Ajax , Aiyer, Rohit , Antony, Ajay, Al‐Kaisy, Adnan , Christelis, Nick , Levy, Robert M. , Deer, Timothy R. , Mehta, Pankaj D , Sayed, Dawood , Grider, Jay S. , Provenzano, David , Slavin, Konstantin V. , Russo, Marc , Fishman, Michael Alan , Mekhail, Nagy
Pain Medicine | February 12, 2020 | Volume: 21 | Issue: 8 | Pages: 1581-1589
AbstractObjectiveTo conduct a systematic literature review of dorsal root ganglion (DRG) stimulation for pain.DesignGrade the evidence for DRG stimulation.MethodsAn international, interdisciplinary work group conducted a literature search for DRG stimulation. Abstracts were reviewed to select studies for grading. General inclusion criteria were prospective trials (randomized controlled trials and observational studies) that were not part of a larger or previously reported group. Excluded studies were retrospective, too small, or existed only as abstracts. Studies were graded using the modified Interventional Pain Management Techniques–Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria.ResultsDRG stimulation has Level II evidence (moderate) based upon one high-quality pivotal randomized controlled trial and two lower-quality studies.ConclusionsModerate-level evidence supports DRG stimulation for treating chronic focal neuropathic pain and complex regional pain syndrome.