Alternative Dorsal Root Ganglion Neuromodulation Electrode Implantation: A Report of 2 Cases with 3 Different Techniques

Schultheis, Björn Carsten
Wille, Christian
Ross-Steinhagen, Nikolas Eugenio
De Ridder, Dirk
Vancamp, Tim
Weidle, Patrick A.

¹Krankenhaus Neuwerk “Maria von den Aposteln,” Muskulo-Skeletales Zentrum, interventionelle Schmerztherapie, Mönchengladbach, Germany
²Department of Neurosurgery, NCN Neurochirurgische Praxis Neuss, Neuss, Neuss, Germany
³Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
⁴e4Sci, Sabadell, Spain

Address for correspondence Björn Carsten Schultheis, MD, Krankenhaus “Maria von den Aposteln,” Muskulo-Skeletales Zentrum, Wirbelsäulentherapie-interventionelle Schmerztherapie, Dünner Strasse 214, 41066 Mönchengladbach, Germany (e-mail: [email protected]).

received

November 3, 2020

accepted after revision

April 23, 2021

article published online

December 12, 2021

Journal of Neurological Surgery : Central European Neurosurgery 84(5):p 477-482, September 2023. | DOI: 10.1055/s-0041-1739219

Abstract

Background and Study Aims

The traditional percutaneous placement of dorsal root ganglion (DRG) electrodes may not be eligible for every patient. In this tertiary spine surgery and interventional pain therapy center, alternative neurostimulation implantation techniques were developed and applied where standard percutaneous approaches failed or were contraindicated.

Case presentation

Three alternative implantation techniques can be used: (1) open surgical placement of DRG leads, (2) two-lead insertion via a lateral to medial transforaminal approach (level L3), and (3) percutaneous approach with two leads close to the spinal nerves L4 (peripheral nerve stimulation).

Results

The placement of the leads occurred without complications and resulted in similar expected outcomes as with the common percutaneous technique with longterm stable pain suppression at 7 months and 1 year.

Conclusions

In patients in whom the DRG cannot be approached by the standard percutaneous approach, at least three alternatives may be used in experienced hands resulting in stable pain suppression of similar magnitude.