Dorsal Root Ganglion Stimulation

By Timothy Deer, MD
President and CEO
The Center for Pain Relief, Inc.
Charleston, WV

 

Background

The dorsal root ganglion (DRG) is an intraspinal structure that is critical in the processing of the pain signal from the peripheral nervous system to its position in the central nervous system. Attempts to place conventional leads to the area of the foramen have failed because of the size of the lead and improper shape. In prospective multicenter studies, innovative design of a lead to fit around the structure delivered via a novel sheath has proven successful at treating patients with focal complex syndromes that have previously failed both spinal cord and peripheral stimulation.  

 

Best Practices

  • DRG stimulation has been approved for clinical use in Europe and Australia and is pending FDA consideration in the United States based on the results of a randomized prospective comparative pivotal study.[1]
  • DRG stimulation has been used successfully to treat neuropathic pain of the limbs, axial back, groin, chest wall, and phantom limb. The anatomy of the DRG allows for stimulation of the abnormal pain fibers more selectively than conventional spinal cord stimulation. This results in less energy requirement and, in many cases in the international population, pain relief at a sub-threshold level that is parasthesia free.[2]
  • Cross talk between DRG structures allows for appropriate selection of the target based on best anatomy of the spine. An MRI or CT of the target area should be considered prior to placement with the realization that the target can be modified to improve safety with maintained efficacy.[3]
  • Trialing of the DRG can be performed via a simple percutaneous method, which was the initial method of approach in the development of the therapy.[4] Proper training and mentoring allows for efficiency and efficacy in the technique. To date, the therapy has been applied by the percutaneous method in all implants, but current work is ongoing in developing a surgical lead.

 

References

  1. A Safety and Effectiveness Trial of Spinal Cord Stimulation of the Dorsal Root Ganglion for Chronic Lower Limb Pain (ACCURRATE) https://clinicaltrials.gov/ct2/show/NCT01923285
  2. Lime L, Russo M, Huygen F, et al. One-year outcomes of spinal cord Stimulation of the dorsal root ganglion in the treatment of chronic neuropathic pain. 2015 Jan;18(1):41-8; discussion 48-9. doi: 10.1111/ner.12228. Epub 2014 Aug 21.
  3. Pope J, Deer T, Kramer J. A systemic review: Current and future directions of dorsal root ganglion therapeutics to treat chronic pain. Pain Med. 2013 Oct;14(10):1477-96. doi: 10.1111/pme.12171. Epub 2013 Jun 26.
  4. Deer T, Grigsby E, Weiner R, Wilcosky B, Kramer J. A prospective study of dorsal root ganglion stimulation for the relief of chronic pain. 2013 Jan-Feb;16(1):67-71; discussion 71-2. doi: 10.1111/ner.12013. Epub 2012 Dec 14.

 

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