Prospective Cohort Analysis of DRG Stimulation for Failed Back Surgery Syndrome Pain Following Lumbar Discectomy

Abstract

Introduction Surgical lumbar discectomy is a commonly performed routine spinal procedure that is usually undertaken to alleviate lumbar radicular symptoms caused by a herniated intervertebral disc. Surgical lumbar discectomy can also lead to chronic postsurgical leg and/or back pain (failed back surgery syndrome [FBSS]), a condition that can be refractory to conventional medical management. Early clinical results on the use of dorsal root ganglion (DRG) stimulation for FBSS have supported the use of this treatment alternative. Methods A multicenter, single‐arm, observational cohort study enrolled patients who had chronic pain following surgical lumbar discectomy, had failed conservative treatments, and reported pain intensity of at least 6 out of 10 in the primary region of pain. Data were collected on pain, quality of life, disability, and mood at baseline and through 12 months. Results Thirteen patients underwent a trial of DRG stimulation; 11 (84.6%; 95% confidence interval = 57.8% to 95.7%) had good outcomes and underwent permanent device placement. Pain was reduced from a score of 8.64 (±0.92) at baseline to 2.40 (±2.38; n = 9) after 12 months of treatment, a 72.05% average reduction (P < 0.001). Similar improvements were observed across the secondary clinical measures, and safety data were in line with published rates. Discussion These results suggest that DRG stimulation induces pain relief in subjects diagnosed with FBSS. These reductions in pain were also associated with improvements in quality of life and disability. Additional prospective studies are warranted to further investigate this potential application of DRG stimulation, as well as to optimize patient selection, lead placement, and programming strategies.

T12 Dorsal Root Ganglion Stimulation to Treat Chronic Low Back Pain: A Case Series

“…These pre‐ and post‐values roughly correspond to normalized values from patients with morbid chronic disease to healthy individuals, respectively . The patients included in Huygen et al showed an EQ‐5D increase from 0.31 to 0.50, similar to the findings in the recent Kallewaard et al publications, with index values increasing from 0.34 to 0.82 and 0.61 to 0.84 at 12 months, respectively, in the FBSS and non‐operated cohorts . Our patients pretreatment demonstrated a similar baseline of 0.30, however, the index score improved to 0.86, with four reporting maximal index values of 1.0.…”

“…Kallewaard et al also described, with bilateral L2 DRG leads, that stimulation relieved low back pain arising from post‐discectomy FBSS as well as from non‐operated discogenic pain . These patients were highly screened with diagnostic injections to specifically focus on discogenic pain, so in these cases placement of DRG‐S leads at the L2 spinal level may represent a treatment focal point for pain originating from the intervertebral disc . Another report documented 61% back pain relief with high frequency DRG/nerve root stimulation at either the L2 or T9 levels, with patients generally preferring T9 lead placement .…”

“…Correspondingly, prior groups placed DRG‐S leads at the L4‐5 level . In contrast, Huygen et al and Kallewaard et al performed DRG‐S on the L2 level based on the notion that a portion of the intervertebral disc and vertebral body sensory innervation is transmitted through sympathetic afferents to the L2 spinal nerve root . This concept for the treatment of low back pain does not support the benefit for patients who have pain that is originating from the posterior aspect of the intervertebral disc and vertebral body, and facet joints, as they are innervated by small sensory branches of the spinal nerve of the adjacent spinal levels .…”

Diagnosis and minimally invasive treatment of chronic discogenic low back pain

“…15 Our prospective study with DRG L2 stimulation in a highly selected group of patients with CD-LBP showed a promising result after 12 months. 16 Further studies are needed to define if there is a place for neurostimulation in CD-LBP in non-operated patients and to find what place it should have in the treatment algorithm of CD-LBP.…”

Utilização de potenciais evocados a laser para avaliação da dor neuropática crônica durante a estimulação do gânglio da raiz dorsal

“…menos conexões centrais), implicando em pouca ou nenhuma habituação, o que pode conferir vantagem adicional ao método sobre outras formas de modulação. Taxas bem-sucedidas de alívio da dor foram observadas em outras séries de casos (Huygen et al, 2017, Mol et al, 2017, van Bussel et al, 2017, Eldabe et al, 2018, Falowski et al, 2018, Hassanain et al, 2018, Kallewaard et al, 2018, Skaribas et al, 2018 bem como em alguns relatos de casos (Garg et al, 2015, Rowland et al, 2016, Zuidema et al, 2016, Maino et al, 2017, Zuidema et al, 2017, Giordano et al, 2018, Goebel et al, 2018, Groenen et al, 2018. Uma série com 217 pacientes avaliados retrospectivamente num estudo multicêntrico demonstrou 66,9% de alivio da dor medida pela EVN durante a triagem quando comparada a linha de base em um grupo de pacientes apresentando diversos tipos de dor neuropática .…”