Billet Bart, Jessen Christian, Moriggl Bernhard, Liu Derrick, Szabo Emily, Nieuwoudt Stephan, Abd-Elsayed Alaa, Soin Amol, Bendtsen Thomas Fichtner
Pain Clinic, AZ Delta, Roeselare, Belgium; RESEARCH Stimulus Group, Vrije Universiteit Brussel, Brussels, Belgium.
Department of Anesthesiology, Horsens Regional Hospital, Horsens, Denmark.
Pain Physician. 2024 Nov;27(8):E899-E907.
Dorsal root ganglion stimulation (DRGS) is an established method for treating persistent and severe pain conditions. However, performing DRGS has significant challenges. Current DRGS systems are expensive, hindering accessibility for many patients and health care systems. Additionally, placing DRGS devices requires specialized training in epidural techniques and lead anchoring methods. Technical and financial requirements also limit the clinical applicability and availability of DRGS.
This study evaluated the feasibility of a new method for rapidly delivering near- DRG stimulation in human cadavers. The method involves a fluoroscopy-guided transforaminal approach using a fully implantable, injectable electrode, and its associated delivery system.
A human cadaver feasibility study.
A cadaver laboratory.
In this study, 3 anesthesiologist pain physicians received training on the injectable electrode device and delivery system using spine phantom models. They then applied the device's associated implantation techniques to 2 adult male cadavers. In the first cadaver, a single injectable electrode was placed near the left L2 lumbar DRG. In the second cadaver, injectable electrodes were placed near the left L1 and L2 DRG levels, and a benchmark DRGS device was installed at the left L1 level using fluoroscopic guidance. A careful anatomical dissection was then performed for each implanted device.
The stimulating contacts of the injectable electrodes were accurately positioned within one mm of the DRG at the lumbar L1 and L2 levels in both cadavers. The distances of both the injectable lead and benchmark DRGS device at the L1 level were measured as one mm from the posterior aspect of the DRG.
The findings of this study are based on anatomical examinations of a limited number of human cadavers and may not fully represent living human anatomy.
To our knowledge, this feasibility cadaver study is the first of its kind to examine the accuracy and efficiency of a fluoroscopy-guided transforaminal approach to place injectable electrodes near the DRG. These promising results suggest that this method could be a viable alternative to existing DRGS techniques, warranting further investigation into its clinical potential.
背根神经节刺激术（DRGS）是治疗持续性和重度疼痛病症的一种既定方法。然而，实施DRGS存在重大挑战。当前的DRGS系统价格昂贵，阻碍了许多患者和医疗保健系统的可及性。此外，放置DRGS设备需要硬膜外技术和导线锚定方法方面的专门培训。技术和资金需求也限制了DRGS的临床适用性和可获得性。
本研究评估了一种在人体尸体中快速进行近背根神经节刺激的新方法的可行性。该方法涉及使用完全可植入、可注射电极及其相关输送系统的透视引导经椎间孔入路。
人体尸体可行性研究。
尸体实验室。
在本研究中，3名麻醉科疼痛医师使用脊柱模型对可注射电极装置和输送系统进行了培训。然后，他们将该装置的相关植入技术应用于2具成年男性尸体。在第一具尸体中，在左L2腰段背根神经节附近放置了一个可注射电极。在第二具尸体中，在左L1和L2背根神经节水平附近放置了可注射电极，并在透视引导下于左L1水平安装了一个基准DRGS装置。然后对每个植入装置进行仔细的解剖。
在两具尸体的L1和L2腰段水平，可注射电极的刺激触点均精确位于距背根神经节1毫米范围内。在L1水平，可注射导线和基准DRGS装置距背根神经节后方的距离均测得为1毫米。
本研究结果基于对有限数量人体尸体的解剖检查，可能无法完全代表活体人体解剖结构。
据我们所知，这项可行性尸体研究是同类研究中首个检验透视引导经椎间孔入路在背根神经节附近放置可注射电极的准确性和效率的研究。这些有前景的结果表明，该方法可能是现有DRGS技术的可行替代方案，值得进一步研究其临床潜力。
