What is Dorsal Root Ganglion Stimulation?

The Dorsal Root Ganglion (DRG) is a small bundle of nerve structures (neurons) connected to the spinal nerves of each vertebra along your spine. The DRG is critical in processing pain signals and transmitting them to your brain. They have a particularly important role in how you experience pain. The DRG act as the body’s internal traffic light: they control when signals can enter the spinal cord, therefore allowing pain signals to travel to the brain.

The Dorsal Root Ganglion neurons modify your sensory perception (how you feel pain) before transmitting the signal to your spinal cord and central nervous system. This makes DRG stimulation an effective treatment approach for patients with chronic pain.

What is Dorsal Root Ganglion Stimulation?

Dorsal Root Ganglion stimulation functions as a Spinal “pacemaker” and utilizes a pulse generator that is implanted on the spine. The implant uses small electrical leads which are threaded into the epidural space where the DRG lies. The leads send a small electrical impulse to the area where the DRG is located. These impulses painlessly “stimulate” the Dorsal Root Ganglion and block any pain signals from that specific area traveling to the brain.

Benefits of DRG Stimulation

There are four specific benefits of targeting the Dorsal Root Ganglion for pain relief:

1. Directed Targeting: Because the stimulating DRG electrodes are implanted exactly where the pain is rooted, DRG stimulation has the ability to provide pain relief in a very specific area. The accuracy of this treatment has proven effective in 94.5% of patients who received targeted areas of pain.
2. 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.
3. Low Risk of Lead Migration: The DRG stimulators are tucked into a small space, limiting the chances of lead migration. There is reported less than 1% migration rate, whereas a traditional SCS reports an approximate 14% migration rate.
4. 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 patterns remain constant regardless of any changes in the body’s position. Whether lying down, sitting down, standing, or walking, the patient receives the same pattern.

Dr. Skaribas performs this procedure for patients who suffer from CRPS or other types of chronic pain. Dr. Skaribas is one of the first interventional pain management Anesthesiologist in the United States that has used the DRG stimulation technology and has been a Proctor and the teacher teaching other physicians had to apply this modality. Dr. Skaribas participated in the Neuromodulation Appropriateness Consensus Committee on Best Practices for Dorsal Root Ganglion Stimulation.

Specific areas that dorsal root ganglion stimulation is applied by include CRPS of the feet, chronic pelvic and pudendal pain, chronic groin pain and chronic knee pain. All these areas can be treated with a specific DRG stimulation. First, a trial DRG Stimulator is fluoroscopically implanted. Dr. Skaribas and his team evaluates the data from the trial and determines if a permanent stimulator is beneficial.

References:

1.The Neuromodulation Appropriateness Consensus Committee on Best Practices for Dorsal Root Ganglion Stimulation

Timothy R. Deer MD Jason E. Pope MD Tim J. Lamer MD Jay S. Grider DO, PhD, MBA David Provenzano MD Timothy R. Lubenow MD James J. FitzGerald PhD Corey Hunter MD Steven Falowski MD Dawood Sayed MD Ganesan Baranidharan MBBS Nikunj K. Patel MD Timothy Davis MD Alex Green MD, BSc, MBBS Antonio Pajuelo MD Lawrence J. Epstein MD Michael Harned MD Liong Liem MD, PhD Paul J. Christo MD, MBA Krishnan Chakravarthy MD, PhD Christopher Gilmore MD Frank Huygen MD, PhD Eric Lee MD, MA Pankaj Metha MD Harold Nijhuis MD Denis G. Patterson DO Erika Petersen MD Julie G. Pilitsis MD, PhD Jeffery J. Rowe MD Matthew P. Rupert MD Ioannis Skaribas MD Jennifer Sweet MD Paul Verrills MD Derron Wilson MD Robert M. Levy MD, PhD Nagy Mekhail MD, PhD

Neuromodulation, Volume22, Issue1, January 2019, Pages 1-35

2. Single S1 Dorsal Root Ganglia Stimulation for Intractable Complex Regional Pain Syndrome Foot Pain After Lumbar Spine Surgery: A Case Series. Ioannis Skaribas MD I Christian Peccora MD Elena Skaribas RS. Neuromodulation. Volume22, Issue1, January 2019, Pages 101-107.