Thissen Jost, De Ridder Dirk, Maciaczyk Jaroslaw, Bara Gregor A
Spine Center, Schoen Clinic Düsseldorf, Düsseldorf, Germany.
Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Neuromodulation. 2022 Oct;25(7):1033-1039. doi: 10.1016/j.neurom.2021.10.022. Epub 2022 Feb 12.
Dorsal root ganglion (DRG) stimulation demonstrated superiority over traditional spinal cord stimulation with better pain relief and greater improvement of quality of life. However, leads specifically designed for DRG stimulation are difficult to implant in patients who previously underwent spinal surgery and show epidural scarring at the desired site of implantation because of the reduced stiffness of the lead. Nevertheless, recurrent leg or arm pain after spinal surgery usually manifests as a single level radiculopathy, which should theoretically be amenable to DRG stimulation.
We present the percutaneous transforaminal placement of cylindrical leads through a lateral endoscopic approach for DRG stimulation in burst mode.
We could successfully show that percutaneous transforaminal lead placement is feasible in three illustrative cases.
This technical note combines two innovations, one linked to the other. The first innovation involves a novel endoscopic lateral transforaminal approach to insert a cylindrical lead to the DRG. Because this electrode is compatible with burst stimulation-enabled devices, a second innovation consists of the application of burst stimulation on the DRG.
背根神经节（DRG）刺激显示出优于传统脊髓刺激的效果，能更好地缓解疼痛并显著改善生活质量。然而，专门为DRG刺激设计的电极难以植入曾接受过脊柱手术且在预期植入部位出现硬膜外瘢痕的患者体内，因为电极的刚度降低。尽管如此，脊柱手术后复发性腿部或手臂疼痛通常表现为单节段神经根病，理论上应适合进行DRG刺激。
我们介绍了通过外侧内镜入路经皮经椎间孔置入圆柱形电极用于突发模式下DRG刺激的方法。
我们成功地在三个典型病例中证明了经皮经椎间孔电极置入是可行的。
本技术说明结合了两项创新，且二者相互关联。第一项创新涉及一种新颖的内镜下外侧经椎间孔入路，将圆柱形电极插入DRG。由于该电极与支持突发刺激的设备兼容，第二项创新是在DRG上应用突发刺激。
