Neuromodulation of the Cervical Dorsal Root Ganglion for Upper Extremity Complex Regional Pain Syndrome-Case Report.

Abstract

Targeting the dorsal column, spinal cord stimulation (SCS) serves as a treatment method for complex regional pain syndrome (CRPS). Certain anatomical pain distributions are difficult to treat with traditional SCS, including the distal extremities. We present a case where stimulation of the dorsal root ganglion (DRG) was performed to treat CRPS in the distal upper extremity. A 43-year-old female underwent a right elbow arthroscopy with open reduction and internal fixation after sustaining a radial head fracture. Several months after her surgery, she experienced hyperesthesia, skin color changes, decreased range of motion, weakness distal to the right olecranon, and was diagnosed with CRPS. Aggressive physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and neuropathic agents provided mild relief. Open capsular release, hardware removal, and chondral debridement of the elbow did not provide alleviation. A diagnostic stellate ganglion block provided complete relief for two weeks. A therapeutic block allowed one day of relief, followed by recurrence of her symptoms. She underwent an SCS trial for treatment. Scar tissue in the posterior epidural space prevented catheter advancement, causing it to exit the C6 foramen. Incidental stimulation of the DRG occurred. On follow-up, patient reported >70% relief of her pain. On the visual analog scale, her maximal pain decreased from 8/10 to 4/10, with resolution of her initial symptoms and ability to perform all of her activities of daily living. To our knowledge, this is the only reported case of utilizing DRG stimulation for CRPS of the distal upper extremity. Neuromodulation of the DRG appears to be an effective option for targeting painful areas in CRPS.