P061: SPINAL CORD STIMULATION NOT AN OPTION? HOW ABOUT DORSAL ROOT GANGLION STIMULATION?
Adejuyigbe O Adaralegbe, MD, Juan Mora, MD, Ajay Antony, MD; Department of Anesthesiology, University of Florida, Gainesville, Florida
Introduction: Chronic low back pain (CLBP) is a condition with a prevalence in adults aged 20-69 in the United States recently estimated to be 13.1%.1 Traditionally, a spinal cord stimulator (SCS) may be offered to patients in whom conservative therapies no longer are effective. Dorsal Root Ganglion (DRG) stimulation is a newer technique employed over the last decade that affords the treatment of focal neuropathic pain.2 For Traditional dorsal column stimulation, thoracic spinal canal stenosis is a relative contraindication when placing leads to treat back pain. We present a patient with severe thoracic stenosis treated with bilateral L2 DRG stimulation.
Case report: A 71 y.o. female presented with chronic low back pain after failing multimodal therapy at an outside facility including physical therapy (PT), activity modification, narcotics, massage therapy, facet joint injections, epidural injections, and rhizotomy – all with minimal succes. After CT scan of the thoracic spine showed severe canal stenosis, the decision was made to trial DRG stimulation at L2.
Results: The patient reported 80% relief after a 7 day trial period. 12 weeks after implantation, the patient reported 80-90% pain relief and a decrease in narcotic use. The patient reported no paresthesias from the stimulation and no postural variation in pain relief or stimulation intensity.
Discussion: DRG-SCS has been shown to be an effective therapy for chronic pain of multiple etiologies – including Complex Regional Pain Syndrome (CRPS) and chronic post-surgical pain. DRG-SCS for axial back pain is an area of growing interest. Future prospective studies are needed for this entity. This report also highlights the importance of screening imaging to detect pathologies that would make lead placement at the intended level unsafe.
1. Shmagel A, Foley R, Ibrahim H. Epidemiology of Chronic Low Back Pain in US Adults: Data From the 2009-2010 National Health and Nutrition Examination Survey. Arthritis care & research. 2016;68(11):1688-1694.
2. Liem L, Russo M, Huygen FJPM, et al. One-Year Outcomes of Spinal Cord Stimulation of the Dorsal Root Ganglion in the Treatment of Chronic Neuropathic Pain. Neuromodulation: Technology at the Neural Interface. 2015;18(1):41-49.