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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Synergetic efficacy of simultaneous DRG- and traditional spinal cord stimulation

Synergistischer Einsatz der Hinterstrang-Ganglion Stimulation und traditioneller SCS

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  • presenting/speaker Philipp J. Slotty - Heinrich-Heine-Universität, Universitätsklinikum, Abteilung für Stereotaxie und Funktionelle Neurochirurgie, Düsseldorf, Deutschland
  • Apostolos Chatzikalfas - Heinrich-Heine-Universität, Universitätsklinikum, Abteilung für Stereotaxie und Funktionelle Neurochirurgie, Düsseldorf, Deutschland
  • Jan Vesper - Heinrich-Heine-Universität, Universitätsklinikum, Abteilung für Stereotaxie und Funktionelle Neurochirurgie, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP113

doi: 10.3205/19dgnc449, urn:nbn:de:0183-19dgnc4490

Published: May 8, 2019

© 2019 Slotty et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Dorsal root ganglion stimulation has established its role in chronic pain states of different origin and is commonly used as an alternative treatment to traditional spinal cord stimulation. Due to its approach, DRG stimulation is preferable used in pain conditions affecting a small area or a distinct nerve root. Traditional spinal cord stimulation can be used to treat larger areas as the back in FBSS. In selected patients, a combination of both techniques might be useful. Little is known about the feasibility, possible technical difficulties in program and efficacy of this combined approach.

Methods: We report a series of 5 patients treated with DRG stimulation and traditional spinal cord stimulation. Four patients suffered from a FBSS syndrome with severe chronic mixed lumbar pain and chronic neuropathic radicular pain, one patient suffered from CRPS. In all but one patient SCS was implanted first and complemented with a DRG in the course (4–90 month between implantation). In all but one patient, DRG and SCS systems came from the same manufacturer.

Results: In all patients, an additional stimulation system was implanted as the previous stimulation, despite reprogramming and revision surgery where considered promising, failed to reach the area of pain. In all but the CRPS patient, DRG stimulation was implanted to reach pain in the groin and/or leg whereas SCS stimulation was used to cover the lumbar pain in these FBSS patients. During programming only one system at a time was activated. No adverse events and no technical difficulties were observed during surgery and programming. All but one patient had a consistent and satisfying therapeutic effect with both systems activated.

Conclusion: The combination of dorsal root ganglion and traditional spinal cord stimulation is surgically and technical feasible. In selected patients the combination of both methods offers an option to amend pain states not sufficiently treatable with one method alone. This introduction of IPGs combining DRG and SCS stimulation paradigms might increase acceptance of this option.