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Cervical and High-Thoracic Dorsal Root Ganglion Stimulation in Chronic Neuropathic Pain.
Neuromodulation. 2019 Dec; 22(8):951-955.N

Abstract

INTRODUCTION

Dorsal root ganglion stimulation is a meanwhile established but rather new technique of neuromodulation to treat chronic pain states of different origin. While being primarily used in the lumbar region, dorsal root ganglion (DRG) stimulation also can be used in the upper thoracic and cervical region with slight alterations of the surgical approach. This offers new therapeutic options especially in the treatment of neuropathic pain states of the upper extremities. Data on surgical technique, outcome and complications rates of DRG in this region are limited.

MATERIALS AND METHODS

We report a consecutive series of 20 patients treated with DRG stimulation in the upper thoracic and cervical region. All patients suffered from chronic neuropathic pain unresponsive to best medical treatment. Main pain etiologies were trauma, spine surgery, postherpetic neuralgia, and peripheral nerve surgery. All patients were trialed with externalized electrodes prior to permanent pulse generator implantation. Routine clinical follow-up was performed during reprogramming sessions.

RESULTS

Out of all 20 patients trialed, 18 were successfully trialed and implanted with a permanent stimulation system. The average pain relief after three months compared to the baseline was of 60.9% (mean VAS 8.5 to VAS 3.2). 77.8% of the patients reported a pain relief of at least 50% after three months. One patient developed a transient paresis of the arm caused by the procedure. She completely recovered within three months.

CONCLUSION

Cervical and upper thoracic DRG stimulation resulted in good overall response rates to trialing and similar pain relief when compared to DRG stimulation for groin and lower limb pain. A modified surgical approach has to be used when compared with lumbar DRG electrode placement. Surgery itself in this region is more complication prone and challenging.

Authors+Show Affiliations

Department of Neurosurgery, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany.Department of Functional Neurosurgery and Stereotaxy, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany.Department of Functional Neurosurgery and Stereotaxy, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany.Department of Functional Neurosurgery and Stereotaxy, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

30620789

Citation

Piedade, Guilherme Santos, et al. "Cervical and High-Thoracic Dorsal Root Ganglion Stimulation in Chronic Neuropathic Pain." Neuromodulation : Journal of the International Neuromodulation Society, vol. 22, no. 8, 2019, pp. 951-955.
Piedade GS, Vesper J, Chatzikalfas A, et al. Cervical and High-Thoracic Dorsal Root Ganglion Stimulation in Chronic Neuropathic Pain. Neuromodulation. 2019;22(8):951-955.
Piedade, G. S., Vesper, J., Chatzikalfas, A., & Slotty, P. J. (2019). Cervical and High-Thoracic Dorsal Root Ganglion Stimulation in Chronic Neuropathic Pain. Neuromodulation : Journal of the International Neuromodulation Society, 22(8), 951-955. https://doi.org/10.1111/ner.12916
Piedade GS, et al. Cervical and High-Thoracic Dorsal Root Ganglion Stimulation in Chronic Neuropathic Pain. Neuromodulation. 2019;22(8):951-955. PubMed PMID: 30620789.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical and High-Thoracic Dorsal Root Ganglion Stimulation in Chronic Neuropathic Pain. AU - Piedade,Guilherme Santos, AU - Vesper,Jan, AU - Chatzikalfas,Apostolos, AU - Slotty,Philipp J, Y1 - 2019/01/08/ PY - 2018/10/16/received PY - 2018/11/07/revised PY - 2018/12/05/accepted PY - 2019/1/9/pubmed PY - 2020/6/2/medline PY - 2019/1/9/entrez KW - Dorsal root ganglion stimulation KW - neuromodulation KW - neuropathic pain SP - 951 EP - 955 JF - Neuromodulation : journal of the International Neuromodulation Society JO - Neuromodulation VL - 22 IS - 8 N2 - INTRODUCTION: Dorsal root ganglion stimulation is a meanwhile established but rather new technique of neuromodulation to treat chronic pain states of different origin. While being primarily used in the lumbar region, dorsal root ganglion (DRG) stimulation also can be used in the upper thoracic and cervical region with slight alterations of the surgical approach. This offers new therapeutic options especially in the treatment of neuropathic pain states of the upper extremities. Data on surgical technique, outcome and complications rates of DRG in this region are limited. MATERIALS AND METHODS: We report a consecutive series of 20 patients treated with DRG stimulation in the upper thoracic and cervical region. All patients suffered from chronic neuropathic pain unresponsive to best medical treatment. Main pain etiologies were trauma, spine surgery, postherpetic neuralgia, and peripheral nerve surgery. All patients were trialed with externalized electrodes prior to permanent pulse generator implantation. Routine clinical follow-up was performed during reprogramming sessions. RESULTS: Out of all 20 patients trialed, 18 were successfully trialed and implanted with a permanent stimulation system. The average pain relief after three months compared to the baseline was of 60.9% (mean VAS 8.5 to VAS 3.2). 77.8% of the patients reported a pain relief of at least 50% after three months. One patient developed a transient paresis of the arm caused by the procedure. She completely recovered within three months. CONCLUSION: Cervical and upper thoracic DRG stimulation resulted in good overall response rates to trialing and similar pain relief when compared to DRG stimulation for groin and lower limb pain. A modified surgical approach has to be used when compared with lumbar DRG electrode placement. Surgery itself in this region is more complication prone and challenging. SN - 1525-1403 UR - https://www.unboundmedicine.com/medline/citation/30620789/Cervical_and_High_Thoracic_Dorsal_Root_Ganglion_Stimulation_in_Chronic_Neuropathic_Pain_ DB - PRIME DP - Unbound Medicine ER -