Alternative Dorsal Root Ganglion Neuromodulation Electrode Implantation: A Report of 2 Cases with 3 Different Techniques

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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Long-term actions of interleukin-1β on K+, Na+ and Ca2+ channel currents in small, IB4-positive dorsal root ganglion neurons; possible relevance to the etiology of neuropathic pain

Journal of Neuroimmunology ◽

10.1016/j.jneuroim.2019.05.002 ◽

2019 ◽

Vol 332 ◽

pp. 198-211 ◽

Cited By ~ 5

Author(s):

Myung-chul Noh ◽

Patrick L. Stemkowski ◽

Peter A. Smith

Keyword(s):

Neuropathic Pain ◽

Dorsal Root Ganglion ◽

Dorsal Root ◽

Dorsal Root Ganglion Neurons ◽

Interleukin 1Β ◽

Ganglion Neurons ◽

Channel Currents

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Long-Term Estrogen Replacement Coordinately Decreases trkA and β-PPT mRNA Levels in Dorsal Root Ganglion Neurons

Experimental Neurology ◽

10.1006/exnr.1998.6999 ◽

1999 ◽

Vol 155 (2) ◽

pp. 260-267 ◽

Cited By ~ 31

Author(s):

Francis J. Liuzzi ◽

Sheila A. Scoville ◽

Susan M. Bufton

Keyword(s):

Dorsal Root Ganglion ◽

Dorsal Root ◽

Dorsal Root Ganglion Neurons ◽

Mrna Levels ◽

Estrogen Replacement ◽

Ganglion Neurons

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The long-term exposure of rat cultured dorsal root ganglion cells to bradykinin induced the release of prostaglandin E2 by the activation of cyclooxygenase-2

Neuroscience Letters ◽

10.1016/j.neulet.2006.03.026 ◽

2006 ◽

Vol 401 (3) ◽

pp. 242-247 ◽

Cited By ~ 23

Author(s):

Atsuko Inoue ◽

Mikiko Iwasa ◽

Yumi Nishikura ◽

Shinya Ogawa ◽

Ayaka Nakasuka ◽

...

Keyword(s):

Dorsal Root Ganglion ◽

Prostaglandin E2 ◽

Dorsal Root ◽

Ganglion Cells ◽

Cyclooxygenase 2 ◽

Dorsal Root Ganglion Cells

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Development of Heat Hyperalgesia and Changes of TRPV1 and NGF Expression in Rat Dorsal Root Ganglion Following Joint Immobilization

Physiological Research ◽

10.33549/physiolres.932280 ◽

2013 ◽

pp. 215-219 ◽

Cited By ~ 1

Author(s):

T. NISHIGAMI ◽

Y. OSAKO ◽

M. IKEUCHI ◽

K. YURI ◽

T. USHIDA

Keyword(s):

Dorsal Root Ganglion ◽

Dorsal Root ◽

Transient Receptor Potential ◽

Wrist Joint ◽

Receptor Potential ◽

Phenotypic Change ◽

Drg Neurons ◽

Limb Immobilization ◽

Heat Hyperalgesia

The aim of this study was to examine whether threshold to heat stimuli, and expression of transient receptor potential vanilloid1 (TRPV1) and nerve growth factor (NGF) in dorsal root ganglion (DRG) altered under conditions of long-term limb immobilization. A plastic cast was wrapped around the right limb from the forearm to the forepaw to keep wrist joint at 90° of flexion for 5 weeks. Heat hyperalgesia was tested using the plantar test at 6 h after removing cast. The rats were perfused transcardially with 4 % paraformaldehyde and DRGs were excised at 24 h after removing cast. For size distributions of the TRPV1-IR and NGF-IR neuronal profile, the DRG area measurements over 1000 DRG neurons per animal were measured in each side, on both the immobilized (ipsilateral) and contralateral sides. Ipsilateral withdrawal latency was significantly shorter than contralateral sides. Ipsilateral percentage of immunoreactive neurons in the total DRG neurons was significantly higher than contralateral sides in TRPV1-IR and NGF-IR. Long-term casting induced heat hyperalgesia, and up-regulation and phenotypic change of TRPV1-IR and NGF-IR in DRGs on the immobilized side. These DRG alterations may involve heat hyperalgesia after long-term limb immobilization.

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Dorsal Root Ganglion Stimulation for the Management of Chronic Neuropathic Pain: A Retrospective Case Series during Four Years follow-up in a Single Center

The Open Pain Journal ◽

10.2174/1876386302013010035 ◽

2020 ◽

Vol 13 (1) ◽

pp. 35-41

Author(s):

Alfonso Papa ◽

Elisabetta Saracco ◽

Maria Teresa Di Dato ◽

Pietro Buonavolontà ◽

Anna Maria Salzano ◽

...

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Dorsal Root Ganglion ◽

Data Collection ◽

Dorsal Root ◽

Case Series ◽

Chronic Neuropathic Pain ◽

Neuropathic Pain Syndrome

Objectives: The dorsal root ganglion (DRG) is involved in the transduction of pain signals to the central nervous system (CNS) and undergoes a number of physiopathological changes during chronic pain. The purpose of this data collection was to evaluate the long-term safety and efficacy of DRG stimulation for the treatment of chronic pain and its impact on functional aspects. Materials and Methods: Forty-four subjects with non-reactive chronic neuropathic pain syndrome were implanted with DRG stimulation. Patients were evaluated at baseline as well as at 15, and 30 days, and at 3, 6, 12, 24, 36 and 48 months after medical intervention/surgery using the Visual Analogic Scale (VAS), which measures pain intensity, and the Oswestry Scale, for the estimation of disability (ODI). Results: After four years of simulation, VAS and ODI showed a statistically significant reduction throughout the follow-up period. The average pain relief obtained after 48 months of treatment was 74.1% ± 3.4. Conclusion: The results of this data collection demonstrate the feasibility of DRG stimulation, the correspondence between the clinical indications at the DRG implant and what is commonly found in the literature on this technique.(18,20) Patients defined as clinical responders to DRG stimulation and so implanted with definitive IPG showed a sustained and long term efficacy. Eight patients had previously been implanted with a traditional SCS without any clinically relevant efficacy; they were then explained for unsatisfactory results. Six of them (75%) were later implanted with DRG, with long-term effectiveness. Another advantage of this therapy is the absence of positional effects and lead migration. The adverse events proved to be independent of the anatomical level of insertion; moreover, this series of cases show a lower incidence of lead migration than reported in the literature. In summary, DRGs have been ignored for too long, probably due to the technical difficulty of reaching their deep, almost extra-spinal anatomical position.

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Long-term non-invasive interrogation of human dorsal root ganglion neuronal cultures on an integrated microfluidic multielectrode array platform

The Analyst ◽

10.1039/c5an01728a ◽

2016 ◽

Vol 141 (18) ◽

pp. 5346-5357 ◽

Cited By ~ 9

Author(s):

H. A. Enright ◽

S. H. Felix ◽

N. O. Fischer ◽

E. V. Mukerjee ◽

D. Soscia ◽

...

Keyword(s):

Dorsal Root Ganglion ◽

Dorsal Root ◽

Microelectrode Array ◽

Multielectrode Array ◽

Neuronal Cultures ◽

Primary Neurons ◽

Chemical Exposures ◽

Non Invasive ◽

Array Platform

Electrophysiology measurements from human primary neurons after repeated chemical exposures are enabled with an integrated microfluidic and microelectrode array device.

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