Vancamp Tim, Levy Robert M, Peña Isaac, Pajuelo Antonio
BRAI2N, St. Augustinus Hospital, Wilrijk, Belgium.
Marcus Neuroscience Institute, Boca Raton, FL, USA.
Neuromodulation. 2017 Oct;20(7):690-702. doi: 10.1111/ner.12651. Epub 2017 Sep 12.
While dorsal root ganglion (DRG) stimulation has been available in Europe and Australia for the past five years and in the United States for the past year, there are no published details concerning the optimal procedures for DRG lead implantation.
We describe several techniques that can be applied to implant cylindrical leads over the DRG, highlighting some tips and tricks according to our experiences. Focus is mainly shifted toward implantations in the lumbar area. We furthermore give some insights in the results we experienced in Spain as well as some worldwide numbers.
A 14-gauge needle is placed using a "2-Level Technique (2-LT)" or exceptionally a "1-Level Technique (1-LT)" or a "Primary- or Secondary Technique" at the level of L5. The delivery sheath, loaded with the lead, is advanced toward the targeted neural foramen. The lead is placed over the dorsal aspect of the DRG. A strain relief loop is created in the epidural space. Sheath and needle are retracted and the lead is secured using an anchor or anchorless technique. In Spain, 87.2% (N = 78) of the selected patients have been successfully implanted. Seven (8.9%) had a negative trial and three (4.2%) were explanted. Average VAS score decreased from 8.8 to 3.3 and on average 94.5% of the pain area was covered. In our center's subjects (N = 47 patients, 60.3% of all implanted patients in Spain), VAS scores decreased from an average of 8.8-1.7 and pain coverage averaged 96.4%. We used an average of 1.8 electrodes. Worldwide more than 4000 permanent cases have been successfully performed.
We present implantation techniques whereby a percutaneous lead is placed over the DRG through the use of a special designed delivery sheath. Further investigation of the safety, efficacy, and sustainability of clinical outcomes using these devices is warranted.
虽然背根神经节（DRG）刺激术在欧洲和澳大利亚已应用了五年，在美国已应用了一年，但尚无关于DRG导联植入最佳手术方法的详细报道。
我们描述了几种可用于在DRG上植入圆柱形导联的技术，并根据我们的经验强调了一些技巧和窍门。重点主要转向腰椎区域的植入。此外，我们还介绍了在西班牙获得的结果以及一些全球数据。
使用“双水平技术（2-LT）”，或在特殊情况下使用“单水平技术（1-LT）”或“初级或次级技术”，在L5水平放置一根14号针。将装有导联的输送鞘管朝目标椎间孔推进。将导联放置在DRG的背侧。在硬膜外间隙形成一个应力消除环。撤回鞘管和针，使用锚定或无锚定技术固定导联。在西班牙，87.2%（N = 78）的选定患者成功植入。7例（8.9%）试验结果为阴性，3例（4.2%）进行了取出手术。平均视觉模拟评分（VAS）从8.8降至3.3，平均94.5%的疼痛区域得到覆盖。在我们中心的受试者中（N = 47例患者，占西班牙所有植入患者的60.3%），VAS评分从平均8.8降至1.7，疼痛覆盖平均为96.4%。我们平均使用1.8个电极。全球范围内已成功完成了4000多例永久性手术。
我们介绍了通过使用特殊设计的输送鞘管将经皮导联放置在DRG上的植入技术。有必要进一步研究使用这些设备的临床结果的安全性、有效性和可持续性。
