The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on Best Practices for Cervical Neurostimulation

Deer, Timothy R.; Russo, Marc; Grider, Jay S.; Pope, Jason E.; Hagedorn, Jonathan M; Weisbein, Jacqueline; Abd‐Elsayed, Alaa; Benyamin, Ramsin; Raso, Louis J.; Patel, Kiran V; Provenzano, David; Kim, Philip S.; Amirdelfan, Kasra; Bolash, Robert; Steegers, Monique; Sullivan, Richard; Verrills, Paul; Carlson, Jon; Kapural, Leo; Diwan, Sudhir; Barolat, Giancarlo; Pahapill, Peter A.; Andrés, José De; Raslan, Ahmed M.; López, José Antonio López; Leong, Michael S.; Attias, Miguel B.; Teddy, Peter J.; Green, Alexander L.; Dario, Alessandro; Piedimonte, Fabián; Chapman, Kenneth B.; Tomycz, Nestor D.; FitzGerald, James J.; Gatzinsky, Kliment; Varshney, Vishal; Gish, Brandon; Lindsey, Brad L.; Buvanendran, Asokumar; Lamer, Tim J.; Slavin, Konstantin V.; Levy, Robert M.

doi:10.1016/j.neurom.2021.10.013

Cited by 12 publications

(14 citation statements)

References 73 publications

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“…The C‐arm awake implantation procedure is more complex at cervical levels than at lumbar, due to the reduced interlaminar space 9 . The smaller size of radicular foramina is also a handicap for the lead placement.…”

Section: Discussionmentioning

confidence: 99%

“…There are different anesthesia techniques to monitor neural status during cervical DRG lead placement; only local anesthetics have been described but may cause patient anxiety, sedation combinations of propofol, fentanyl or midazolam and recently the use of dexmedetomidine without negative effects on the respiratory function also have been described 17 . If general anesthesia is necessary, intraoperative neural neuromonitoring with electrophysiology is recommended while performing a cervical implant 9 …”

Section: Discussionmentioning

confidence: 99%

“…17 If general anesthesia is necessary, intraoperative neural neuromonitoring with electrophysiology is recommended while performing a cervical implant. 9 Collaboration with the patient is very important because it informs the implanter about intraoperative coverage. This is especially important at C8 or T1 levels, our preferred targets for treatment of refractory CRPS of the hand with DRG stimulation.…”

Section: Discussionmentioning

confidence: 99%

“…The preferred initial site for lead placement is C8 for all the reasons described before: more density of sympathetic fibers than the upper levels, crosstalk effect between the DRGs of the brachial plexus, and a major neural and vascular damage risk at superior cervical levels. 5,9,10 If lead placement at C8 proved not to obtain a good paresthesia coverage of the painful area during the intraoperative testing, the lead was moved to T1 during the same procedure. No leads were placed above the C8 level.…”

Section: Level Selectionmentioning

confidence: 99%

“…8 Finally, recently published recommendations on best practices for cervical neurostimulation suggest DRG stimulation should be limited to the lower cervical spine. 9 When considering DRG stimulation at the cervical level, key anatomical elements should be considered as follows: (1) the epidural space is wider in the lower cervical levels, 9 (2) the vertebral artery bisects the transverse process canal, ventral to the DRG until the C7 level, when the artery leaves the canal, 10 and (3) the ligamentum flavum may not be present at levels above C6. 11,12 For all these reasons electrical modulation of the C8 and T1 DRG may be the ideal site for CRPS affecting the hand and wrist.…”

Section: Introductionmentioning

confidence: 99%

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Cervical dorsal root ganglion stimulation for complex regional pain syndrome: Technical description and results of seven cases

et al. 2022

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Introduction Complex regional pain syndrome (CRPS) is characterized by nociplastic pain with alterations in sympathetic function. Neuromodulation could be a useful alternative therapy option. Dorsal root ganglion (DRG) stimulation has demonstrated better results than conventional spinal cord stimulation (SCS) for patients with CRPS in lower limbs. Methods We report a case series of seven patients treated with cervical DRG stimulation for CRPS of the hand that required neuromodulation for pain relief, after no response with other analgesic techniques (medication and interventional). We report retrospective data collection of seven consecutive patients with a 1‐year follow‐up. Results Seven patients were trialed, and six were implanted with a permanent pulse generator after achieving more than 50% pain relief during 2–7 days of trial phase. The average pain relief (rated on a standard 100 mm visual analog scale) after 1 year of treatment was 64.3% ± 16.6. No major complications were observed during a 1‐year follow‐up. Discussion The results for cervical DRG stimulation are similar to other DRG stimulation studies for the treatment of refractory CRPS at lower levels. The cervical DRG implant technique guided with C‐arm fluoroscopy and under conscious sedation could be a safe and effective option for relieving pain of the upper limbs CRPS. Monitoring neural status is required for cervical DRG stimulation either with a responder awake patient or with intraoperative neural monitoring in non‐responder patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%