scholarly journals Response to Letter to the Editor Regarding “Complications and Effects of Dorsal Root Ganglion Stimulation in the Treatment of Chronic Neuropathic Pain: A Nationwide Cohort Study in Denmark”

2020 ◽  
Vol 23 (7) ◽  
pp. 1047-1047
Author(s):  
Mattias Horan ◽  
Morten Rune Blichfeldt‐Eckhardt
Keyword(s):  
Neuropathic Pain ◽  
Cohort Study ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Chronic Neuropathic Pain ◽  
Letter To The Editor

A Prospective Analysis of Neuromonitoring for Confirmation of Lead Placement in Dorsal Root Ganglion Stimulation

2017 ◽  
Vol 14 (6) ◽  
pp. 654-660 ◽  
Author(s):  
Steven M Falowski ◽  
Andreas Dianna
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Evoked Potential ◽  
Somatosensory Evoked Potential ◽  
Prospective Analysis ◽  
Awake Patient ◽  
Chronic Neuropathic Pain ◽  
Lead Placement

Abstract BACKGROUND Dorsal root ganglion stimulation is a neuromodulation therapy used for chronic neuropathic pain. Typically, patients are awakened intraoperatively to confirm adequate placement. OBJECTIVE To determine whether neuromonitoring can confirm placement in an asleep patient. METHODS This is a prospective analysis of 12 leads placed in 6 patients. Lead confirmation was confirmed by awake intraoperative testing, as well as asleep testing utilizing neuromonitoring. Patients were used as their own control. Sensory and motor thresholds for each patient with awake and asleep neuromonitoring testing were recorded. Intraoperative impedance and postoperative programming were also recorded. RESULTS In each patient, paresthesias were generated prior to motor contractions in the awake patient. For each patient, somatosensory evoked potential responses were present after lowering below the dropout threshold of electromyogram responses with neuromonitoring. There were varying degrees of separation in the thresholds that did not appear to be consistent across level or diagnosis. Smaller degrees of separation between thresholds during awake testing also held true in the asleep patient. This was further confirmed with postoperative programming. Impedances did not alter the separation in thresholds or amount of stimulation required for responses. One patient was combative during awake testing, and therefore motor thresholds were not obtained. This same patient was determined to have a ventral placement, confirmed with awake and asleep neuromonitoring testing. CONCLUSION This series demonstrates that the proposed neuromonitoring protocol can be used in an asleep patient to assure proper positioning of the dorsal root ganglion electrode in the dorsal foramen by generating somatosensory evoked potential responses in the absence of electromyogram responses.

The Dorsal Root Ganglion in the Pathogenesis of Chronic Neuropathic Pain

Neurosurgery ◽  
2016 ◽  
Vol 63 (CN_suppl_1) ◽  
pp. 118-126 ◽  
Author(s):  
Daipayan Guha ◽  
Mohammed F. Shamji
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Chronic Neuropathic Pain

scholarly journals Dorsal Root Ganglion Stimulation for the Management of Chronic Neuropathic Pain: A Retrospective Case Series during Four Years follow-up in a Single Center

2020 ◽  
Vol 13 (1) ◽  
pp. 35-41
Author(s):  
Alfonso Papa ◽  
Elisabetta Saracco ◽  
Maria Teresa Di Dato ◽  
Pietro Buonavolontà ◽  
Anna Maria Salzano ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Data Collection ◽  
Dorsal Root ◽  
Case Series ◽  
Chronic Neuropathic Pain ◽  
Neuropathic Pain Syndrome

Objectives: The dorsal root ganglion (DRG) is involved in the transduction of pain signals to the central nervous system (CNS) and undergoes a number of physiopathological changes during chronic pain. The purpose of this data collection was to evaluate the long-term safety and efficacy of DRG stimulation for the treatment of chronic pain and its impact on functional aspects. Materials and Methods: Forty-four subjects with non-reactive chronic neuropathic pain syndrome were implanted with DRG stimulation. Patients were evaluated at baseline as well as at 15, and 30 days, and at 3, 6, 12, 24, 36 and 48 months after medical intervention/surgery using the Visual Analogic Scale (VAS), which measures pain intensity, and the Oswestry Scale, for the estimation of disability (ODI). Results: After four years of simulation, VAS and ODI showed a statistically significant reduction throughout the follow-up period. The average pain relief obtained after 48 months of treatment was 74.1% ± 3.4. Conclusion: The results of this data collection demonstrate the feasibility of DRG stimulation, the correspondence between the clinical indications at the DRG implant and what is commonly found in the literature on this technique.(18,20) Patients defined as clinical responders to DRG stimulation and so implanted with definitive IPG showed a sustained and long term efficacy. Eight patients had previously been implanted with a traditional SCS without any clinically relevant efficacy; they were then explained for unsatisfactory results. Six of them (75%) were later implanted with DRG, with long-term effectiveness. Another advantage of this therapy is the absence of positional effects and lead migration. The adverse events proved to be independent of the anatomical level of insertion; moreover, this series of cases show a lower incidence of lead migration than reported in the literature. In summary, DRGs have been ignored for too long, probably due to the technical difficulty of reaching their deep, almost extra-spinal anatomical position.

scholarly journals Chronic Neuropathic Pain Induces DNA Methylation Changes in the Dorsal Root Ganglion

Neurosurgery ◽  
2018 ◽  
Vol 83 (5) ◽  
pp. E203-E204
Author(s):  
Kevin T Huang ◽  
David L Penn ◽  
John H Chi
Keyword(s):  
Dna Methylation ◽  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Chronic Neuropathic Pain
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