Lumbar Transgrade Dorsal Root Ganglion Stimulation Lead Placement in Patients with Post-Surgical Anatomical Changes: A Technical Note
SourcePain Practice, 20, 4, (2020), pp. 399-404
Article / Letter to editor
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SubjectRadboudumc 18: Healthcare improvement science RIHS: Radboud Institute for Health Sciences
BACKGROUND: Stimulation of the dorsal root ganglion (DRG-S) has been shown to be an efficacious treatment option for refractory neuropathic pain syndromes. However, placement of the percutaneous leads for trial implantation can be challenging in patients with prior spinal surgical interventions resulting in anatomical changes and adhesions. METHODS: This technical report describes the transgrade placement of DRG-S leads in 4 patients with back pain surgery histories in whom secondary to specific anatomical pathologies the traditional anterograde placement of DRG-S leads was not feasible. RESULTS: We used a transgrade placement approach, entering superior and contralateral to the target level of placement, resulting in uncomplicated and effective placement of DRG-S leads. CONCLUSIONS: Transgrade lead placement for DRG-S may be an efficacious alternative to traditional anterograde DRG lead placement in cases where interlaminar access below the level of the DRG is not available, or desirable. Further studies are needed to clarify the safety and applicability of this approach.
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