Article
Predictability of dorsal root ganglion stimulation via prior PRT injection for the treatment of peripheral neuropathies
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Authors
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Gregor A. Bara
- Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
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Stefan Schu
- Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
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Jan Vesper
- Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
| Published: | May 21, 2013 |
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Outline
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Objective: DRG stimulation is an emerging therapy for targeting specific areas of the body, which are hard to treat by conventional spinal cord stimulation. Traditionally the implant procedure requires intensive intra-operative testing of the paresthesia coverage in an awake surgery setting. Often patients are unable to differentiate between the paresthesia produced in superficial or deep visceral layers resulting in misplacement of the lead.
Method: 10 subjects with peripheral neuropathies due to nerve entrapment during prior surgeries were injected on different target levels with Lidocaine in a CT-guided approach. Anesthetized regions were compared with the pain regions overlap. The best match has been chosen as the implant target level to implant a DRG-Neuromodulation lead under general anesthesia. If the pain was not covered by a PRT injection on a single level, multilevel injections have been done. Leads were placed at the T11, T12, L1 or L2 DRGs and stimulation parameters were programmed to direct paresthesia to the subjects’ regions of pain.
Results: DRG stimulation resulted in paresthesias directed at the regions of pain and subsequent pain relief in all areas of pain for all subjects. The positive predicted value of the Lidocaine injection compared to the paresthesia coverage leading to pain reduction was 90%. No complications or adverse events occurred. All subjects received a fully-implantable neurostimulator. The negative predictive value of PRT was 10%
Conclusions: The results of this case series suggest that PRT injections prior to lead implantation is an excellent method to verify the right implant target site and spinal level. It offers the possibility to perform the procedure under general anesthesia without the need of intra-operative testing to confirm paresthesia overlap. The neuromodulation of the dorsal root ganglion is a viable treatment for chronic neuropathic pain in difficult anatomic areas. Investigation of long-term DRG stimulation in subjects with a variety of clinical indications is ongoing.
