Lumbar and Sacral Nerve Root Stimulation (NRS) in the Treatment of Chronic Pain: A Novel Anatomic Approach and Neuro Stimulation Technique

Alò, Kenneth M.; Yland, Marc J.; Redko, Vladimir; Feler, Claudio A.; Naumann, Claus

doi:10.1046/j.1525-1403.1999.00023.x

Cited by 100 publications

(77 citation statements)

References 16 publications

(17 reference statements)

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“…There are pros and cons for each approach. A transsacral foraminal approach of sacral nerve stimulation has been associated with technical failures in maintaining electrode position and inconsistent outcomes [7]. The advantages of the retrograde approach are the low rate of migration, low risk of infection, and good coverage of the pain site [8].…”

Section: Discussionmentioning

confidence: 99%

Sacral Nerve Stimulation Through the Sacral Hiatus

Park

Kim

2012

Korean J Pain

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Sacral nerve stimulation through the retrograde approach has been used for peroneal or irritable bowel syndrome through the retrograde approach. However, several reasons, lead could not be advanced down ward. In this case, anterograde sacral nerve stimulation through the sacral hiatus could be used. The aim of this report is to present of technique of sacral nerve root stimulation through the sacral hiatus approach.

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Section: Discussionmentioning

confidence: 99%

Sacral Nerve Stimulation Through the Sacral Hiatus

Park

Kim

2012

Korean J Pain

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“…Once placed at the epidural space, a 19-gauge radio-opaque spring-tipped epidural catheter with a wire stylet (Theracath®; Arrow International, PA, USA) was passed in a caudal direction into the epidural space [10]. If resistance was met, the catheter was removed and the needle placement rechecked and readjusted if necessary (The catheter should advance easily, and should never be forced).…”

Section: Methodsmentioning

confidence: 99%

Fluoroscopic analysis of lumbar epidural contrast spread after retrograde interlaminar ventral epidural injection (RIVEI)

Jeong

Shim

Woo

2013

Korean J Anesthesiol

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BackgroundRetrograde interlaminar ventral epidural injection (RIVEI) may hypothetically be more effective if the catheter is placed at the ventrocaudal aspect of the exiting nerve. We tested that hypothesis by measuring ventral and dorsal epidural contrast flow during RIVEI.MethodsTo perform RIVEI, a 17 G Tuohy needle was inserted to access the epidural space. A 19 G epidural catheter was inserted and advanced through the needle, passing in a caudal direction to the lower aspect of the contralateral pedicle. Fluoroscopic images were recorded at 1.5 ml increments of contrast. Based on the images of contrast dispersal, the extent of contrast spreading was assessed in 82 patients.ResultsAll 82 patients (100%) injected with 3.0 ml contrast medium demonstrated ventral epidural spreading. Mean spreading level from the catheter tip was 2.21 ± 0.93 with 3.0 ml of contrast. Spreading to the superior aspect of the supra-adjacent intervertebral disc was observed in 67/82 (81.7%) of RIVEIs with 3.0 ml of contrast injected into the ventral epidural space. We found that 3.0 ml of contrast reached the inferior aspect of the infra-adjacent intervertebral disc in 95.1% (78/82) of RIVEIs performed.ConclusionsOur findings imply that a one-level RIVEI may be sufficient in situations where a two-level injection would currently be used.

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“…[85][86][87] In humans, epidural SCS implantation techniques were modified to bring electrodes in close apposition to dorsal nerve roots (the proximal dendrites of neurons), with some success in achieving adequate paresthesia coverage of painful areas and resultant pain relief. 88,89 Attempts to target the DRG directly for neuromodulation were laborious, 90 as gaining access to the foramen with conventional tools was cumbersome. Recently, a specially designed SCS system incorporating highly flexible small-diameter leads has been introduced, allowing electrodes to be apposed with the DRG cell bodies in the vertebral foramen via standard retrograde percutaneous placement under fluoroscopic guidance.…”

Section: Stimulation-based Therapiesmentioning

confidence: 99%

The Dorsal Root Ganglion as a Therapeutic Target for Chronic Pain

Liem

Dongen

Huygen

et al. 2016

Regional Anesthesia and Pain Medicine

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Chronic neuropathic pain is a widespread problem with negative personal and societal consequences. Despite considerable clinical neuroscience research, the goal of developing effective, reliable, and durable treatments has remained elusive. The critical role played by the dorsal root ganglion (DRG) in the induction and maintenance of chronic pain has been largely overlooked in these efforts, however. It may be that, by targeting this site, robust new options for pain management will be revealed. This review summarizes recent advances in the knowledge base for DRG-targeted treatments for neuropathic pain:• Pharmacological options including the chemical targeting of voltage-dependent calcium channels, transient receptor potential channels, neurotrophin production, potentiation of opioid transduction pathways, and excitatory glutamate receptors.• Ablation or modulation of the DRG via continuous thermal radiofrequency and pulsed radiofrequency treatments.• Implanted electrical neurostimulator technologies.• Interventions involving the modification of DRG cellular function at the genetic level by using viral vectors and gene silencing methods.

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Lumbar and Sacral Nerve Root Stimulation (NRS) in the Treatment of Chronic Pain: A Novel Anatomic Approach and Neuro Stimulation Technique

Cited by 100 publications

References 16 publications

Sacral Nerve Stimulation Through the Sacral Hiatus

Sacral Nerve Stimulation Through the Sacral Hiatus

Fluoroscopic analysis of lumbar epidural contrast spread after retrograde interlaminar ventral epidural injection (RIVEI)

The Dorsal Root Ganglion as a Therapeutic Target for Chronic Pain

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