gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Molecular inflammatory and sensory phenotyping in CRPS patients treated with unilateral L4-dorsal root ganglion stimulation

Die Effekte der L4 Ganglionstimulation auf das molekular-inflammatorische und sensorische Profil von neuropathischen Schmerzpatienten

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Thomas Kinfe - Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Neurosurgery, Division Functional Neurosurgery and Stereotaxy, Erlangen, Deutschland
  • Andreas Stadlbauer - Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Neurosurgery, Erlangen, Deutschland
  • Michael Buchfelder - Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Neurosurgery, Erlangen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV269

doi: 10.3205/21dgnc256, urn:nbn:de:0183-21dgnc2563

Veröffentlicht: 4. Juni 2021

© 2021 Kinfe et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Objective: Complex regional pain syndrome have been associated with a pro-inflammatory state driven by different circulating mediators. Dorsal root ganglion stimulation (DRGSTIM) suppressed pain levels and improved functional capacity in intractable CRPS in observational and randomized-controlled studies. However, in-human studies evaluating the effects of selective DRG stimulation using objective outcome measures remains under-investigated.

Methods: This pilot study performed molecular inflammatory phenotyping (saliva/serum), gene expression assay of neuroinflammatory genes (PantherTM pathway enrichment analysis), quantitative sensory profiling and score-based assessment of pain, mood and sleep in 24 subjects (12 CRPS patients - 12 healthy controls) before and after 3 months of selective L4-DRGSTIM.

Results: After L4-DRGSTIM CRPS pain significantly decreased with improved sleep and mood. Elevated levels were found pre- and post L4-DRGSTIM for high-mobility group box 1, tumor-necrosis factor α, IL-6 and leptin indicating a pro-inflammatory state in CRPS patients. IL-1β was elevated pre-L4 DRGSTIM, but not post-treatment. IL-10 decreased after 3 months in serum, while saliva oxytocin increased after L4-DRGSTIM (Figure 1 [Fig. 1]). Gene expression analysis demonstrated down-regulated TLR1, FFAR2, IL1RAP, ILRN, C5, PKB and IL18 and upregulated CXCL2, CCL11, IL36G, CRP, SCGB1A1, IL-17F, TNFRSF4, PLA2G2A, CREB3L3, ADAMTS12, IL1F10, NOX1, CHIA and BDKRB1. CRPS subjects showed significantly increased thresholds for warmth, tactile and vibration detection (WDT, MDT and VDT) and exaggerated pain summation (WUR). After 3 months of unilateral L4-DRGSTIM all pain parameters exhibited trends towards normalization of sensitivity accumulating to a significant overall normalization for pain sensitivity (effect size: 0.91, p<0.01). Reduction of pain summation (WUR) correlated significantly with pain reduction after 3 months of L4-DRGSTIM.

Conclusion: L4-DRGSTIM promoted pain relief and improved functional impairment in CRPS patients revealing a pro-inflammatory molecular pattern. Serum IL-10 significantly declined, while saliva oxytocin increased after L4-DRGSTIM. Sub-group analysis demonstrated either upregulated or downregulated genes involved in immune host response and neural pain circuits and evoked significant normalization in the pain domain of the somatosensory profile. Thermoreception and mechanoreception remained unchanged.

Figure 2 [Fig. 2]