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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Predictability of dorsal root ganglion stimulation via prior transforaminal epidural injections for the treatment of peripheral neuropathies

Meeting Abstract

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  • Gregor A. Bara - Department of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich-Heine University Duesseldorf, Germany
  • Philipp J. Slotty - Department of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich-Heine University Duesseldorf, Germany
  • Jaroslaw Maciaczyk - Department of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich-Heine University Duesseldorf, Germany
  • Stefan Schu - Department of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich-Heine University Duesseldorf, Germany
  • Jan Vesper - Department of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich-Heine University Duesseldorf, Germany

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 106

doi: 10.3205/14dgnc502, urn:nbn:de:0183-14dgnc5025

Published: May 13, 2014

© 2014 Bara et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: DRG stimulation is an emerging therapy for targeting radicular pain syndromes, 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: 21 subjects with peripheral neuropathies due to nervous damage 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 directly at the regions of pain and subsequently 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 95.2% (n=20). No complications or adverse events occurred. All subjects received a fully-implantable neurostimulator.

Conclusions: The results of this case series suggest that periradicular 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.