Single S1 Dorsal Root Ganglia Stimulation for Intractable Complex Regional Pain Syndrome Foot Pain After Lumbar Spine Surgery: A Case Series

Skaribas, Ioannis; Peccora, Christian; Skaribas, Elena E.

doi:10.1111/ner.12780

Cited by 17 publications

(20 citation statements)

References 10 publications

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“…Morgalla et al reported 63.5% overall pain relief and improvement in BPI scores under DRGS in patients with post-herniorraphy inguinal pain, which was sustained even after three years of observation (14). These successful rates of pain relief have been replicated in other more recent smaller case series (11,55,56) as well as in some case reports (13,16,18,19,26). In our study, we had 74% mean pain reduction at one month and 70% at six-month postsurgery.…”

Section: Drg Stimulationsupporting

confidence: 75%

Neurophysiological Effects of Dorsal Root Ganglion Stimulation (DRGS) in Pain Processing at the Cortical Level

Morgalla

Filho

Chander

et al. 2019

Neuromodulation: Technology at the Neural Interface

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Section: Drg Stimulationsupporting

confidence: 75%

Neurophysiological Effects of Dorsal Root Ganglion Stimulation (DRGS) in Pain Processing at the Cortical Level

Morgalla

Filho

Chander

et al. 2019

Neuromodulation: Technology at the Neural Interface

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“…Included studies analyzed the following painful conditions: CRPS,1–3,31–36 LBP,5,6,37–40 groin pain,7,8,41 pelvic girdle pain,9,10 peripheral neuropathy,29,30,42 peripheral diabetic neuropathy,43 phantom limb pain,44 chronic intractable pain in the coccyx,45 chronic testicular pain,46 anterior cutaneous nerve entrapment syndrome (ACNES),47 loin pain hematuria syndrome (LPHS) 48…”

Section: Resultsmentioning

confidence: 99%

“…Three studies were before and after comparisons, including a total of 71 participants during the trial period of stimulation and 44 for permanent implantation 2,3,31. There were five case reports that included 17 participants in total 32–36…”

Section: Resultsmentioning

confidence: 99%

<p>Neuromodulation with electrical field stimulation of dorsal root ganglion in various pain syndromes: a systematic review with focus on participant selection</p>

Vuka¹,

Marciuš²,

Došenović³

et al. 2019

JPR

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Objective We conducted a systematic review about patient selection, efficacy, and safety of neuromodulation with electrical field stimulation (EFS) of dorsal root ganglion (DRG) in various painful conditions. We also analyzed conclusion statements as well as conflict of interest and financing of the included studies. Methods All study designs were eligible for inclusion. We searched MEDLINE, CINAHL, Embase, PsycINFO, and clinical trial registries until September 7, 2018. We assessed risk of bias by using Cochrane tool for randomized controlled trials (RCTs). Results Among the 29 included studies, only one was RCT, majority being case series and case reports. The evidence is based on studies with small number of participants (median: 6, range 1–152) with various painful conditions. Neuromodulation with EFS of DRG was mostly performed in participants who have failed other treatment modalities. Most of the authors of the included studies reported positive, but inconclusive, evidence regarding efficacy of neuro-modulation with EFS of DRG. Meta-analysis was not possible since only one RCT was included. Conclusion Available evidence suggest that neuromodulation with EFS of DRG may help highly selected participants with various pain syndromes, who have failed to achieve adequate pain relief with other pharmacological and nonpharmacological interventions. However, these findings should be confirmed in high-quality RCTs with sufficient numbers of participants.

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“…Given the DRG's ability to modulate afferent sympathetic fibers with very low-frequency stimulation, DRG-S has the potential to be a powerful neuromodulatory tool for DPN. In our experience, an S1 lead is usually sufficient to cover neuropathic pain of the entire foot, including the L4 and L5 dermatomes, as was seen in this case [ 20 ].…”

Section: Discussionmentioning

confidence: 97%

Unilateral Dorsal Root Ganglion Stimulation Lead Placement With Resolution of Bilateral Lower Extremity Symptoms in Diabetic Peripheral Neuropathy

Chapman¹,

Roosendaal²,

Helmond³

et al. 2020

Cureus

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Dorsal root ganglion stimulation (DRG-S) is a form of neuromodulation that can target specific dermatomes to obtain better coverage of the distal extremity. Previously proposed mechanisms of action for DRG-S focused on the dorsal root ganglion (DRG) itself, without consideration of orthodromic effects in the dorsal horn and antidromic effects on the nerve root and sympathetic chain. Diabetic peripheral neuropathy (DPN) is an axonal neuropathy that affects around half of all patients with diabetes mellitus, causing severe pain and sensory impairment in the distal extremities. We present a case of a patient with DPN in both feet, in addition to low back pain, who underwent a DRG-S trial with right T12 and S1 leads. The trial was performed unilaterally for seven days, allowing the patient to compare the treated versus the untreated (left) side. Pain, disability, general health status, and quality of life measures improved significantly. In addition to the significant pain relief in the low back and feet, the patient had near resolution of other DPN-related symptoms, including numbness, bluish discoloration, and allodynia of both feet. He also demonstrated functional and psychological benefits with only a single-sided lead. Overall, the placement of unilateral T12 and S1 DRG-S leads resulted in symmetric improvement of DPN symptoms. A possible mechanism of action is antidromic propagation of action potential signaling into the sympathetic chain to a central ganglion and then to the contralateral sympathetic chain. Given the DRG's ability to directly affect afferent sympathetic fibers with low-frequency stimulation, DRG-S may be an effective neuromodulatory treatment for DPN.

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Single S1 Dorsal Root Ganglia Stimulation for Intractable Complex Regional Pain Syndrome Foot Pain After Lumbar Spine Surgery: A Case Series

Cited by 17 publications

References 10 publications

Neurophysiological Effects of Dorsal Root Ganglion Stimulation (DRGS) in Pain Processing at the Cortical Level

Neurophysiological Effects of Dorsal Root Ganglion Stimulation (DRGS) in Pain Processing at the Cortical Level

<p>Neuromodulation with electrical field stimulation of dorsal root ganglion in various pain syndromes: a systematic review with focus on participant selection</p>

Unilateral Dorsal Root Ganglion Stimulation Lead Placement With Resolution of Bilateral Lower Extremity Symptoms in Diabetic Peripheral Neuropathy

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