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Santiago N, Monaco BA, Santos Piedade G, Jagid J, Cordeiro JG. Navigated Dorsal Root Ganglion Stimulation (DRGS) for the Treatment of Chronic Refractory Coccygodynia: A Case Report. Cureus 2023; 15:e41663. [PMID: 37575765 PMCID: PMC10412402 DOI: 10.7759/cureus.41663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/15/2023] Open
Abstract
Sacral stimulation is a well-established therapy for urologic neuromodulation. After the advent of dorsal root ganglion (DRG) stimulation, pain surgeons have started to reach this target mostly for pelvic and sacral pain. For those without good surgical experience, sacral foramen puncture, especially S3 and S4, can be a challenge, due to its entry angle and limited C-arm image resolution. In this report, we describe a new technique to utilize sacral navigation using the O-arm approach to guide DRG stimulation implants. We discuss a case of a 53-year-old male patient with refractory coccygodynia, who underwent sacral DRG implantation using neuronavigation. Punctures could be done without the need for multiple attempts to reach the foramen in this patient.
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Affiliation(s)
- Natally Santiago
- Neurological Surgery, Beneficência Portuguesa de São Paulo, São Paulo, BRA
| | - Bernardo A Monaco
- Neurological Surgery, University of Miami, Miami, USA
- Neurological Surgery, CDF - Clinica de Dor e Funcional, São Paulo, BRA
- Neurological Surgery, University of Sao Paulo, São Paulo, BRA
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Chapman KB, Sayed D, Lamer T, Hunter C, Weisbein J, Patel KV, Dickerson D, Hagedorn JM, Lee DW, Amirdelfan K, Deer T, Chakravarthy K. Best Practices for Dorsal Root Ganglion Stimulation for Chronic Pain: Guidelines from the American Society of Pain and Neuroscience. J Pain Res 2023; 16:839-879. [PMID: 36942306 PMCID: PMC10024474 DOI: 10.2147/jpr.s364370] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/17/2023] [Indexed: 03/14/2023] Open
Abstract
With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion stimulation (DRG-S) has significantly improved the treatment of complex regional pain syndrome (CRPS), and it has broad applicability across a wide range of other conditions. Through funding and organizational leadership by the American Society for Pain and Neuroscience (ASPN), this best practices consensus document has been developed for the selection, implantation, and use of DRG stimulation for the treatment of chronic pain syndromes. This document is composed of a comprehensive narrative literature review that has been performed regarding the role of the DRG in chronic pain and the clinical evidence for DRG-S as a treatment for multiple pain etiologies. Best practice recommendations encompass safety management, implantation techniques, and mitigation of the potential complications reported in the literature. Looking to the future of neuromodulation, DRG-S holds promise as a robust intervention for otherwise intractable pain.
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Affiliation(s)
- Kenneth B Chapman
- The Spine & Pain Institute of New York, New York, NY, USA
- Department of Anesthesiology, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
- Department of Anesthesiology, NYU Langone Medical Center, New York, NY, USA
- Correspondence: Kenneth B Chapman, NYU Langone Medical Center, Zucker School of Medicine at Hofstra/Northwell, Pain Medicine at Staten Island University Hospital, 1360 Hylan Boulevard, Staten Island, NY, 10305, USA, Email
| | - Dawood Sayed
- Department of Anesthesiology, The University of Kansas Medical Center (KUMC), Kansas City, KS, USA
| | - Tim Lamer
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Corey Hunter
- Ainsworth Institute of Pain Management, New York, NY, USA
| | | | - Kiran V Patel
- The Spine & Pain Institute of New York, New York, NY, USA
- Department of Anesthesiology, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
- Department of Anesthesiology, NYU Langone Medical Center, New York, NY, USA
| | - David Dickerson
- Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University Health System, Evanston, IL, USA
- Department of Anesthesia & Critical Care, University of Chicago, Chicago, IL, USA
| | | | - David W Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | | | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Krishnan Chakravarthy
- Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
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Schultheis BC, Wille C, Ross-Steinhagen NE, De Ridder D, Vancamp T, Weidle PA. Alternative Dorsal Root Ganglion Neuromodulation Electrode Implantation: A Report of 2 Cases with 3 Different Techniques. J Neurol Surg A Cent Eur Neurosurg 2021. [PMID: 34897626 DOI: 10.1055/s-0041-1739219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND STUDY AIMS The traditional percutaneous placement of dorsal root ganglion (DRG) electrodes may not be eligible for every patient. In this tertiary spine surgery and interventional pain therapy center, alternative neurostimulation implantation techniques were developed and applied where standard percutaneous approaches failed or were contraindicated. CASE PRESENTATION Three alternative implantation techniques can be used: (1) open surgical placement of DRG leads, (2) two-lead insertion via a lateral to medial transforaminal approach (level L3), and (3) percutaneous approach with two leads close to the spinal nerves L4 (peripheral nerve stimulation). RESULTS The placement of the leads occurred without complications and resulted in similar expected outcomes as with the common percutaneous technique with long-term stable pain suppression at 7 months and 1 year. CONCLUSIONS In patients in whom the DRG cannot be approached by the standard percutaneous approach, at least three alternatives may be used in experienced hands resulting in stable pain suppression of similar magnitude.
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Affiliation(s)
- Björn Carsten Schultheis
- Krankenhaus Neuwerk "Maria von den Aposteln," Muskulo-Skeletales Zentrum, interventionelle Schmerztherapie, Mönchengladbach, Germany
| | - Christian Wille
- Department of Neurosurgery, NCN Neurochirurgische Praxis Neuss, Neuss, Neuss, Germany
| | - Nikolas Eugenio Ross-Steinhagen
- Krankenhaus Neuwerk "Maria von den Aposteln," Muskulo-Skeletales Zentrum, interventionelle Schmerztherapie, Mönchengladbach, Germany
| | - Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Patrick A Weidle
- Krankenhaus Neuwerk "Maria von den Aposteln," Muskulo-Skeletales Zentrum, interventionelle Schmerztherapie, Mönchengladbach, Germany
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Johnson R, Seibly JM. Open Surgical Placement of T9-T12 Dorsal Root Ganglion Stimulators With Titanium Plate Anchor Fixation in a Patient With Recalcitrant Post-herpetic Neuralgia. Cureus 2021; 13:e15040. [PMID: 34150391 PMCID: PMC8202441 DOI: 10.7759/cureus.15040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dorsal root ganglion stimulators (DRGS) have been used to treat patients with neuropathic pain due to multiple etiologies. Typically, DRGS are inserted percutaneously with fluoroscopic guidance epidurally into the neuroforamina over a pathologic dorsal root ganglion. In patients with unfavorable anatomy due to extensive surgical scarring, an open surgical approach has been described in the literature for DRGS placement. We document an alternative open surgical approach for DRGS placement in a patient with recalcitrant post-herpetic neuralgia.
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Affiliation(s)
- Ryan Johnson
- Neurosurgery, Carle BroMenn Medical Center, Normal, USA
| | - Jason M Seibly
- Neurosurgery, Central Illinois Neuroscience Foundation, Bloomington, USA
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