Open AccessEffectiveness of “Transgrade” Epidural Technique for Dorsal Root Ganglion Stimulation. A Retrospective, Single-Center, Case Series for Chronic Focal Neuropathic Pain
Author(s) -
Adnan AlKaisy,
Jonathan Royds,
Matteo Costanzi,
Gabor B. Racz,
Samuel Wesley,
Stefano Palmisani,
David Pang,
Thomas Yearwood
Publication year - 2019
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2019.22.601
Subject(s) - medicine , neuropathic pain , deep brain stimulation , dorsal root ganglion , neuromodulation , retrospective cohort study , anesthesia , surgery , stimulation , dorsum , disease , parkinson's disease , anatomy
Background: The recent interest in targeting the dorsal root ganglion (DRG) has led to thedevelopment of new techniques of electrode placement. In this article, we describe a new“Transgrade” approach to the DRG, accessing the contralateral interlaminar space and steeringthe lead out the opposite foramen.Objectives: The purpose of this study was to evaluate the Transgrade technique to the DRG inthe management of focal neuropathic pain, predominately complex regional pain syndrome interms of efficacy and safety.Study Design: A retrospective, observational review of all patients selected for DRG stimulationusing the Transgrade technique to the DRG.Setting: Pain Management and Neuromodulation Centre, Guys and St. Thomas NHS FoundationTrust, London, United Kingdom.Methods: Data were taken from a hospital password-protected database. All patients werecontacted by telephone for Numeric Rating Scale (NRS-11) score, Patient Global Impression ofChange (PGIC) score, and complications. A patient responder was defined as having a PGIC scoreof 6 or 7, and a 2-point reduction from baseline NRS-11.Results: A total of 39 patients (46% women) with a mean age of 46 years (± 2) underwent a trialof DRG stimulation that resulted in an implantation rate of 82% (32 of 39). The responder rates,according to NRS-11 and PGIC results, were 87% (28 of 32) at 6 weeks and 66% (21 of 32) at amean of 18 months (± 1.8) follow-up. Pocket pain was the most common complication, occurringin 7 of 32 (22%) patients, and the lead migration rate was 3 out of 57 leads placed (5.2%). Aburst protocol was the favored method of stimulation in the majority of patients, 25 of 32 (78%).Limitations: Retrospective nature of design, small sample size.Conclusions: The Transgrade technique of placing DRG leads offers an alternative method thatis safe and effective. New methods of stimulation to the DRG offer more choice and potentiallybetter efficacy for patients with chronic neuropathic pain.