Dorsal Root Ganglion Stimulation Overview
A Targeted Neurostimulation Therapy for Those Suffering from Complex Regional Pain Syndrome
For over 40 years, spinal cord stimulation has been used to help thousands of patients to manage chronic, severe pain. Around the world, tens of thousands of patients undergo spinal cord stimulator implants each year. Spinal cord stimulation (SCS) delivers mild electrical stimulation to nerves along the spinal column, modifying nerve activity to minimize the sensation of pain reaching the brain.
Since this therapy first entered routine use in the 1980s it has been improved and refined significantly. Advances have continued to enable closer customization to each patient’s individual needs. However, spinal cord stimulation does not work for everyone.
In February 2016, the U.S. Food and Drug Administration approved a new neurostimulation treatment called Dorsal Root Ganglion (DRG) stimulation. This was initially targeted for patients with Complex Regional Pain Syndrome (CRPS I and II) in the lower extremities. It is used in areas that were previously difficult to reach with conventional spinal cord stimulation.
Dorsal Root Ganglion
The nervous system in our bodies has two components: the central nervous system (CNS) and the peripheral nervous system (PNS). The central nervous system consists primarily of the brain and spinal cord. The peripheral nervous system consists of nerves and ganglia, which lie outside the brain and the spinal cord.
The main function of the peripheral nervous system (PNS) is to connect the central nervous system (CNS) to the limbs and organs. Essentially, it serves as a relay between the brain and spinal cord, and the rest of the body.
The dorsal root ganglia are clusters of neurons in the posterior root of spinal nerves. (Ganglia, by the way, is the plural of the word “ganglion”.) Every sensory perception entering the spinal cord must first pass through a dorsal root ganglion – collectively, the ganglia serve as the sensory gate to the spinal cord.
Accordingly, the dorsal root ganglia are part of the peripheral nervous system, and it sends peripheral nerve pain signals to the brain. It represents a focal point where those pain signals can be efficiently intercepted and quieted by dorsal root ganglion (DRG) neurostimulation.
Dorsal Root Ganglion (DRG) Stimulation
Dorsal root ganglion (DRG) stimulation is an outpatient neuromodulation therapy, similar to traditional spinal cord (SCS) stimulation. However, rather than placing the electrodes over the posterior aspect of the spinal cord as in SCS, small electrical leads are threaded into the epidural space where the dorsal root ganglion lies.
Dorsal Root Ganglion stimulation utilizes a pulse generator implanted on the spine. That generator is connected to the small electrical leads – providing pain signal blocking, small electrical impulse stimulation at a patient’s control. The impulses create a slight tingling sensation in the affected area, or has the ability to stop the pain altogether.
The Benefits of DRG Stimulation Over SCS
There are several specific advantages of Dorsal Root Ganglion stimulation over Spinal Cord Stimulation:
- Directed Targeting: Because the stimulator lead is implanted exactly where the pain is rooted, DRG stimulation has the ability to provide pain relief in a very specific targeted area.
- Low Energy: DRG stimulators use a tiny amount of energy – only about 10% of the energy that is required from a conventional spinal cord stimulator. The batteries in the DRG stimulator last longer because of the low energy requirement.
- Low Risk of Lead Migration: The DRG stimulators are tucked into a small space, limiting the chances of lead migration.
- Minimal Effects on Body Position: Due to the DRG’s location in the epidural space, the cerebrospinal fluid in between electrodes does not affect the patient’s posture or body position. The stimulation effects remain constant regardless of any changes in the body’s position. Whether lying down, sitting down, standing, or walking, the patient receives the same pain relief.
Dorsal Root Ganglion Stimulation at Main Line Spine
The FDA has approved Dorsal Root Ganglion stimulation for lower extremity Complex Regional Pain Syndrome (CRPS), which could include neuropathic pain conditions and chronic pain following foot, knee, groin, and other surgeries. DRB isn’t a replacement for Spinal Cord Stimulation, but an alternative for appropriate clinical situations where SCS is inadequate.
Accordingly, determining if it is an appropriate alternative requires consultation with an expert in DRG as well as other neuromodulation therapies. While physicians trained in the DRG stimulation procedure are limited, fortunately Main Line Spine’s Dr. Jeffery Rowe is a leading intenational expert based in the greater Philadelphia, Delaware Valley.
If you believe you or a patient of yours may be an appropriate candidate for DRG, please contact Main Line Spine for a consultation with Dr. Rowe.