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J Neurol Surg A Cent Eur Neurosurg 2023; 84(05): 477-482
DOI: 10.1055/s-0041-1739219
Technical Note

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

Björn Carsten Schultheis
1   Krankenhaus Neuwerk “Maria von den Aposteln,” Muskulo-Skeletales Zentrum, interventionelle Schmerztherapie, Mönchengladbach, Germany
,
Christian Wille
2   Department of Neurosurgery, NCN Neurochirurgische Praxis Neuss, Neuss, Neuss, Germany
,
Nikolas Eugenio Ross-Steinhagen
1   Krankenhaus Neuwerk “Maria von den Aposteln,” Muskulo-Skeletales Zentrum, interventionelle Schmerztherapie, Mönchengladbach, Germany
,
Dirk De Ridder
3   Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
,
Tim Vancamp 
4   e4Sci, Sabadell, Spain
,
Patrick A. Weidle
1   Krankenhaus Neuwerk “Maria von den Aposteln,” Muskulo-Skeletales Zentrum, interventionelle Schmerztherapie, Mönchengladbach, Germany
› Author Affiliations Funding This manuscript was prepared with financial support from Abbott, Inc.
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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 long-term 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.

Keywords

dorsal root ganglion - alternative implantation techniques - neuropathic pain - total knee arthroplasty - peripheral nerve stimulation

Author Contributions

B.C.S. was responsible for the selection of the patients. B.C.S., C.W. and P.A.W. were responsible for the conception of the applied implantation techniques, and the observations during the surgical procedures. They also designed the outline of the study. All authors were involved in the acquisition, analysis, and interpretation of data. T.V. and B.C.S. managed the literature searches and summaries of previous related work and wrote the first draft of the manuscript. B.C.S. and N.E.R.S. took the pictures. T.V. edited and configured the pictures as presented in the manuscript. B.C.S., D.D.R. and T.V. prepared the final manuscript. C.W., N.E.R.S. and P.A.W. provided revision for intellectual content. All authors provided final approval of the manuscript. All authors contributed to the manuscript in accordance with the ICMJE guidelines for authorship.




Publication History

Received: 03 November 2020

Accepted: 23 April 2021

Article published online:
12 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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