Dorsal root ganglion stimulation lead fractures: potential mechanisms and ways to avoid

Chauhan, Gayatri; Roth, Brandon; Mekhail, Nagy

doi:10.1136/bcr-2020-241353

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…The DRG is hypothesized to play a vital role in processing, modulating, and maintaining chronic pain signals [ 6 ]. DRGS is a spinal neuromodulation technique designed to target DRG neurons and is considered superior to conventional treatment for difficult-to-treat pain diagnoses such as complex regional pain syndrome [ 7 ]. DRGS is reported to be effective for chronic pelvic pain, including pain secondary to neurectomy of ilioinguinal, iliohypogastric, and genitofemoral nerves [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Dorsal Root Ganglion Stimulation for the Management of Phantom Bladder Pain: A Case Report

Thalla,

Levy,

Pribonic

et al. 2024

Cureus

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Phantom bladder pain, a rare condition following cystectomy, can pose a challenge to pain management providers. We present the case of a 43-year-old male who developed severe phantom bladder pain post-cystectomy. Despite multiple treatments, his symptoms persisted, significantly affecting his quality of life. Dorsal root ganglion stimulation (DRGS) was attempted after conventional therapies failed. The DRGS trial provided significant relief, leading to permanent implantation and a 90% reduction in pain. This case highlights DRGS as a potential treatment for phantom bladder pain, expanding its applications beyond traditional uses. Further research is needed to elucidate its mechanisms and broader applicability.

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Section: Discussionmentioning

confidence: 99%

Dorsal Root Ganglion Stimulation for the Management of Phantom Bladder Pain: A Case Report

Thalla,

Levy,

Pribonic

et al. 2024

Cureus

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“…As looping creates a focal area of entrapment, this stress increases lead fracture occurrence. 7 Separate case reports have found that the locations outside of the epidural space where the S-loops are located also increase the risk of lead fracture. This occurs in the adipose tissue posterior to the thoracolumbar fascia, where the lead passes through multiple layers of fascia and membranous tissue, which can cause bending of the lead at acute angles and increased tension on the lead.…”

Section: Discussionmentioning

confidence: 99%

“…described in a similar DRG‐S lead fracture case report, this lead design also compromises the lead's structural integrity. As looping creates a focal area of entrapment, this stress increases lead fracture occurrence 7 . Separate case reports have found that the locations outside of the epidural space where the S‐loops are located also increase the risk of lead fracture.…”

Section: Discussionmentioning

confidence: 99%

Case report: Dorsal root ganglion stimulator lead fracture

Kochat,

Byers,

2023

Pain Practice

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BackgroundOne of the unique advances in neuromodulation for chronic pain has been spinal cord stimulators (SCS) and dorsal root ganglion stimulators (DRG‐S). These devices have aided in conditions such as neuropathic pain, complex regional pain syndromes, failed back surgery, and peripheral neuropathies. With these benefits, however, complications from implantable stimulators have included lead fractures and migration. The authors reviewed a lead migration, kinking, and subsequent fracture event involving a patient with complex regional pain syndrome (CRPS) II, who was treated with a DRG‐S.Case PresentationThe case report follows this patient, from their past medical history to assessment of appropriate qualifications for neuromodulation, to successful surgical placement, to follow‐up care. The authors further monitored assessment of inefficacy of pain relief, and identification of lead migration and kinking through imaging. In the process of removal, due to lead stress, lead fracturing occurred. After lead removal, the leads were fully replaced, and the patient was followed up and experienced improved pain relief.ConclusionThe case report assesses probable mechanisms of lead fracture and considerations for physicians for future assessment and triage of neuromodulation efficacy.

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“…Two factors have been associated with lead fracture: Entrapment within the superficial fascial plane, and tension from the oblique trans-paraspinal muscle approach. 177,229 This has led to the introduction of a new implant technique using a paramedian, ipsilateral approach. 178 The authors recommend conscientious anchoring below the fascial planes, when possible, to reduce migration and lead fracture.…”

Section: Dovepressmentioning

confidence: 99%

Best Practices for Dorsal Root Ganglion Stimulation for Chronic Pain: Guidelines from the American Society of Pain and Neuroscience

Chapman¹,

Sayed²,

Lamer³

et al. 2023

JPR

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With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion stimulation (DRG-S) has significantly improved the treatment of complex regional pain syndrome (CRPS), and it has broad applicability across a wide range of other conditions. Through funding and organizational leadership by the American Society for Pain and Neuroscience (ASPN), this best practices consensus document has been developed for the selection, implantation, and use of DRG stimulation for the treatment of chronic pain syndromes. This document is composed of a comprehensive narrative literature review that has been performed regarding the role of the DRG in chronic pain and the clinical evidence for DRG-S as a treatment for multiple pain etiologies. Best practice recommendations encompass safety management, implantation techniques, and mitigation of the potential complications reported in the literature. Looking to the future of neuromodulation, DRG-S holds promise as a robust intervention for otherwise intractable pain.

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Dorsal root ganglion stimulation lead fractures: potential mechanisms and ways to avoid

Cited by 5 publications

References 14 publications

Dorsal Root Ganglion Stimulation for the Management of Phantom Bladder Pain: A Case Report

Dorsal Root Ganglion Stimulation for the Management of Phantom Bladder Pain: A Case Report

Case report: Dorsal root ganglion stimulator lead fracture

Best Practices for Dorsal Root Ganglion Stimulation for Chronic Pain: Guidelines from the American Society of Pain and Neuroscience

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