The Spine & Pain Institute of New York, New York, New York, U.S.A.
Department of Anesthesiology, New York University Langone Medical Center, New York, New York, U.S.A.
Pain Pract. 2020 Sep;20(7):780-786. doi: 10.1111/papr.12901. Epub 2020 May 21.
Dorsal root ganglion stimulation (DRG-S) has emerged as a treatment for complex regional pain syndrome (CRPS) of the lower extremities, and recent small studies are demonstrating its potential efficacy in pain syndromes that are traditionally considered nociceptive in nature, such as axial low back pain. While improvements in neuromodulation technology have been substantial over the past decade, with DRG-S systems patients occasionally require additional interventional pain treatments for treatment of pain from other sources. Radiofrequency ablation (RFA) of medial branch nerves innervating the facet joints is an accepted therapy for pain arising from the facet joints.
We describe 2 cases from the same practice where we observed similar phenomena while performing a 2-needle monopolar lumbar RFA in patients with a DRG-S system implanted with leads positioned bilaterally at the S1 DRGs.
Initiation of RFA resulted in motor activation and discomfort in an S1 distribution in the legs in both individual cases.
RFA can interfere with implanted DRG-S systems, resulting in overstimulation with motor recruitment. Specific anatomical considerations and device settings that may prevent interference are discussed.
背根神经节刺激（DRG-S）已成为治疗下肢复杂性区域疼痛综合征（CRPS）的一种方法，最近的一些小型研究表明，它在传统上被认为是伤害性疼痛的疼痛综合征中具有潜在疗效，例如轴向腰痛。虽然在过去十年中，神经调节技术有了实质性的改进，但对于来自其他来源的疼痛，DRG-S 系统的患者偶尔仍需要额外的介入性疼痛治疗。射频消融（RFA）治疗支配小关节突关节的内侧支神经是治疗小关节突关节疼痛的一种公认疗法。
我们描述了来自同一实践的 2 个病例，在对植入双侧 S1 背根神经节的 DRG-S 系统的患者进行 2 针单极腰椎 RFA 时，我们观察到了类似的现象。
在这 2 个病例中，RFA 的启动导致腿部 S1 分布区的运动激活和不适感。
RFA 可能会干扰植入的 DRG-S 系统，导致过度刺激和运动募集。讨论了可能预防干扰的具体解剖考虑因素和设备设置。
