Performing lead placement in the awake patient may reduce such risk, as may the utilization of intra-operative neuromonitoring (IONM). Sacral neurologic injury in particular has also been reported with sacral nerve stimulation (SNS) from urologic experience. Insult to neural structures can cause a neuritis, paresthesia, or weakness, and although commonly self-limiting, longer-term injuries during lead placement in asleep, unmonitored patients have been reported. Recognition of the sensitivity of the DRG to mechanical stimuli during placement has led to raised awareness of anesthetic management and the procedural approach. Īnesthesia for placement of a trial or permanent DRG device has evolved since the early cases were performed. This becomes apparent when comparing the pivotal ACCURATE study’s use of only a single S1 lead, to a 2021 pooled analysis of 756 DRG-S leads which included 248 S1 leads, or 32.8% of the total. This more accessible approach increased utilization, and led to the improved understanding of S1 DRG-S’ therapeutic potential, specifically, the multi-dermatomal coverage of neuropathic buttock, leg, and foot pain that DRG-S at S1 provides. Sacral DRG-S leads were initially placed using a retrograde technique, which was supplanted by the posterior transforaminal approach. Additionally, an ipsilateral, paramedian approach for thoracolumbar DRG-S lead placement was described to decrease lead fracture and enable an alternative technique to the wider-angled contralateral approach. Anchoring the 1-mm DRG-S lead has proven to be an integral step in decreasing lead migration and potentially lead fracture. Ī developing appreciation for the interplay between DRG-S’ implantable components and methods and the resulting specific anatomical structures in device failure and patient injury is driving technique evolution to improve safety and efficacy. With DRG-S, a curved introducer sheath is used to steer and deploy the lead through the foramen and then over the dorsal root ganglion (DRG), followed by ‘S’ tension loop placement. When compared to dorsal column spinal cord stimulation (SCS) lead placement, DRG-S requires a significantly different technique for electrode placement that continues to evolve. Dorsal root ganglion stimulation (DRG-S) utilizes a shaped electrical field placed over the somata of primary afferent nerve fibers.
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