Artikel
Stimulation of the dorsal root ganglion – clinical experience and patient sample of a single-centre
Stimulation des Hinterwurzelganglions – klinische Erfahrungen und ein Patientenkollektiv eines Zentrums
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Autoren
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Dirk Rasche
- Universität zu Lübeck, Klinik für Neurochirurgie, Lübeck, Deutschland
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Volker Tronnier
- Universität zu Lübeck, Klinik für Neurochirurgie, Lübeck, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: In the past decade a lot of evidence is reported for the importance of the dorsal root ganglion (DRG) for transmission, modulation and filtering of peripheral pain signals to the spinal cord. The clinical experiences and results of a prospective patient cohort of a single neuromodulation center are presented.
Methods: Starting in 2012 a total number of 47 patients (23 female, 24 male, age: 23–89 years) were treated with DRGS. All patients suffered from refractory chronic neuropathic pain following trauma, surgery or nerve injury of the upper (18), lower (7) extremities or the trunk (22). Implantation of quadripolar leads (total: 142 leads) was performed from the spinal ganglion of C5 down to S1, with respect to the patient’s pain area. A test trial for at least one week was conducted. In case of pain reduction of at least 30% on the numeric rating scale (NRS) and concomitant withdrawal of analgesics, indication for implantation of a permanent stimulation device was set.
Results: Successful implantation of the DRG-leads was performed in all patients. At least two, not more than four leads were implanted, corresponding to the patient’s pain area. After the test trial 45/47 (96%) patients reported a significant pain reduction and also withdrawal of analgesics was initiated. The neurostimulation device was implanted in general anaesthesia in the subcutaneous tissue at the buttock or abdominal region. Postoperative follow-up controls ranged from 3 months up to 6.5 years. A total number of 40 procedures were necessary in the sample, including 18 battery replacements, but also revision surgery due to lead or extension breakage, dislocation of the lead etc. Explantation of the devices was performed in two patients due to ineffectiveness after 2 and 5 years.
Conclusion: Stimulation of the DRG offers a new, safe and efficient treatment opportunity for chronic neuropathic pain patients and well-located pain areas. Favorable indications are pain syndromes following hernia surgery, knee surgery or complex regional pain syndromes of the upper or lower extremities. Clinical results were disappointing for post-herpetic pain. This specific procedure should be performed only in experienced or certified centers for neuromodulation an invasive pain treatment.
