scholarly journals S3 Dorsal Root Ganglion/Nerve Root Stimulation for Refractory Postsurgical Perineal Pain: Technical Aspects of Anchorless Sacral Transforaminal Lead Placement

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
X. Zuidema ◽  
J. Breel ◽  
F. Wille
Keyword(s):  
Dorsal Root Ganglion ◽  
Nerve Root ◽  
Dorsal Root ◽  
Pain Treatment ◽  
Perineal Pain ◽  
Sexual Activities ◽  
Transforaminal Approach ◽  
Lead Placement ◽  
Chronic Perineal Pain ◽  
Root Stimulation

Chronic perineal pain limits patients in physical and sexual activities, leading to social and psychological distress. In most cases, this pain develops after surgery in the urogenital area or as a consequence of trauma. Neuromodulation is one of the options in chronic postsurgical perineal pain treatment. We present a case of refractory perineal pain after right sided surgical resection of a Bartholin’s cyst which was treated with third sacral nerve root/dorsal root ganglion stimulation using the transforaminal approach. We describe a new anchorless lead placement technique using a unique curved lead delivery sheath. We postulate that this new posterior foraminal technique of lead placement is simple, safe, and reversible and may lower the occurrence of lead related complications.

A Prospective Analysis of Neuromonitoring for Confirmation of Lead Placement in Dorsal Root Ganglion Stimulation

2017 ◽  
Vol 14 (6) ◽  
pp. 654-660 ◽  
Author(s):  
Steven M Falowski ◽  
Andreas Dianna
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Evoked Potential ◽  
Somatosensory Evoked Potential ◽  
Prospective Analysis ◽  
Awake Patient ◽  
Chronic Neuropathic Pain ◽  
Lead Placement

Abstract BACKGROUND Dorsal root ganglion stimulation is a neuromodulation therapy used for chronic neuropathic pain. Typically, patients are awakened intraoperatively to confirm adequate placement. OBJECTIVE To determine whether neuromonitoring can confirm placement in an asleep patient. METHODS This is a prospective analysis of 12 leads placed in 6 patients. Lead confirmation was confirmed by awake intraoperative testing, as well as asleep testing utilizing neuromonitoring. Patients were used as their own control. Sensory and motor thresholds for each patient with awake and asleep neuromonitoring testing were recorded. Intraoperative impedance and postoperative programming were also recorded. RESULTS In each patient, paresthesias were generated prior to motor contractions in the awake patient. For each patient, somatosensory evoked potential responses were present after lowering below the dropout threshold of electromyogram responses with neuromonitoring. There were varying degrees of separation in the thresholds that did not appear to be consistent across level or diagnosis. Smaller degrees of separation between thresholds during awake testing also held true in the asleep patient. This was further confirmed with postoperative programming. Impedances did not alter the separation in thresholds or amount of stimulation required for responses. One patient was combative during awake testing, and therefore motor thresholds were not obtained. This same patient was determined to have a ventral placement, confirmed with awake and asleep neuromonitoring testing. CONCLUSION This series demonstrates that the proposed neuromonitoring protocol can be used in an asleep patient to assure proper positioning of the dorsal root ganglion electrode in the dorsal foramen by generating somatosensory evoked potential responses in the absence of electromyogram responses.

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

2021 ◽  
Author(s):  
Björn Carsten Schultheis ◽  
Christian Wille ◽  
Nikolas Eugenio Ross-Steinhagen ◽  
Dirk De Ridder ◽  
Tim Vancamp ◽  
...  
Keyword(s):  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Percutaneous Technique ◽  
Percutaneous Approach ◽  
Case Presentation ◽  
Transforaminal Approach ◽  
Implantation Techniques ◽  
Interventional Pain Therapy ◽  
Therapy Center

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.

Lumbar Transgrade Dorsal Root Ganglion Stimulation Lead Placement in Patients with Post‐Surgical Anatomical Changes: A Technical Note

Pain Practice ◽  
2020 ◽  
Vol 20 (4) ◽  
pp. 399-404
Author(s):  
Kenneth B. Chapman ◽  
Ryan R. Ramsook ◽  
Pauline S. Groenen ◽  
Kris C. Vissers ◽  
Noud Helmond
Keyword(s):  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Technical Note ◽  
Anatomical Changes ◽  
Lead Placement

A stereological study of dorsal root ganglion cells and nerve root fibers from rats exposed to mercury vapor

1998 ◽  
Vol 96 (2) ◽  
pp. 185-190 ◽  
Author(s):  
Jørgen Drasbæk Schiønning ◽  
Jytte Overgaard Larsen ◽  
Rune Eide
Keyword(s):  
Dorsal Root Ganglion ◽  
Nerve Root ◽  
Dorsal Root ◽  
Ganglion Cells ◽  
Mercury Vapor ◽  
Dorsal Root Ganglion Cells
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