Abstract
Introduction
The invaluable contribution of the stimulation of the dorsal root ganglion due to its initial efficacy and its support over time1, makes it necessary to propose alternative access routes to the dorsal root ganglion as an alternative to an inaccessible epidural pathway.
Methods/Materials
Percutaneous lateral access to the left l5 foramen is presented in a patient with repeated postlaminectomy neuropathy that presented a left l5 neuropathy that had been refractory to standard spinal stimulation and that after external percutaneous access (see images) adequate stimulation both in coverage and analgesic efficacy.
Results
This exceptional route can be contemplated in the future not only as an alternative route for difficult access by epidural route according to the classical technique (tip on tip)2 but also as a novel way to study from the point of view of additional efficacy in certain cases of focused neuropathic pain. It could also be considered as an alternative route to a microsurgical access3 that could be placed in an intermediate route of surgical aggressiveness.
Discussion
This exceptional route can be contemplated in the future not only as an alternative route for difficult access by epidural route according to the classical technique (tip on tip)2 but also as a novel way to study from the point of view of additional efficacy in certain cases of focused neuropathic pain.
Conclusions
It could also be considered as an alternative route to a microsurgical access3 that could be placed in an intermediate route of surgical aggressiveness.
References
1.- Levy R. et al: Therapy Habituation at 12 Months: Spinal Cord Stimulation Versus Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome Type I and II. J Pain. 2019 Sep 5
2.- Vancamp T., Levy R.M., Pena I., Pajuelo A. Relevant Anatomy, Morphology, and Implantation Techniques of the Dorsal Root Ganglia at the Lumbar Levels. Neuromodulation 2017; E-pub ahead of print. DOI:10.1111/ner.12651
3.- Piedade G.S., Cornelius J.F., Chatzikalfas A., Vesper J., Slotty P.J. 2019. Open Microsurgical Dorsal Root Ganglion Lead Placement. Neuromodulation 2019; 22: 956–959
