Cervical and High-Thoracic Dorsal Root Ganglion Stimulation in Chronic Neuropathic Pain

Abstract

Dorsal root ganglion stimulation is a meanwhile established but rather new technique of neuromodulation to treat chronic pain states of different origin. While being primarily used in the lumbar region, dorsal root ganglion (DRG) stimulation also can be used in the upper thoracic and cervical region with slight alterations of the surgical approach. This offers new therapeutic options especially in the treatment of neuropathic pain states of the upper extremities. Data on surgical technique, outcome and complications rates of DRG in this region are limited. We report a consecutive series of 20 patients treated with DRG stimulation in the upper thoracic and cervical region. All patients suffered from chronic neuropathic pain unresponsive to best medical treatment. Main pain etiologies were trauma, spine surgery, postherpetic neuralgia, and peripheral nerve surgery. All patients were trialed with externalized electrodes prior to permanent pulse generator implantation. Routine clinical follow-up was performed during reprogramming sessions. Out of all 20 patients trialed, 18 were successfully trialed and implanted with a permanent stimulation system. The average pain relief after three months compared to the baseline was of 60.9% (mean VAS 8.5 to VAS 3.2). 77.8% of the patients reported a pain relief of at least 50% after three months. One patient developed a transient paresis of the arm caused by the procedure. She completely recovered within three months. Cervical and upper thoracic DRG stimulation resulted in good overall response rates to trialing and similar pain relief when compared to DRG stimulation for groin and lower limb pain. A modified surgical approach has to be used when compared with lumbar DRG electrode placement. Surgery itself in this region is more complication prone and challenging.