The Pathways and Processes Underlying Spinal Transmission of Low Back Pain: Observations From Dorsal Root Ganglion Stimulation Treatment
BackgroundDorsal root ganglion stimulation (DRG ‐S) is a novel approach to treat chronic pain. Lead placement at L2 has been reported to be an effective treatment for axial low back pain (LBP) primarily of discogenic etiology. We have recently shown, in a diverse cohort including cases of multilevel instrumentation following extensive prior bac k surgeries, that DRG‐S lead placement at T12 is another promising target. Local effects at the T12 DRG, alone, are insufficient to explain these results.Materials and MethodsWe performed a literature review to explore the mechanisms of LBP relief with T12 DRG ‐S.FindingsBranches of individual spinal nerve roots innervate facet joints and posterior spinal structures, while the discs and anterior vertebrae are carried via L2, and converge in the dorsal horn (DH) of the spinal cord at T8 ‐T9. The T12 nerve root contains cutaneous afferents from the low back and enters the DH of the spinal cord at T10. Low back Aδ and C‐fibers then ascend via Lissauer's tract (LT) to T8‐T9, converging with other low back afferents. DRG‐S at T12, then, results in inhibition of the converged l ow back fibers via endorphin‐mediated and GABAergic frequency‐dependent mechanisms. Therefore, T12 lead placement may be the optimal location for DRG‐S to treat LBP.
Conditions: Low Back Pain; Pain Measurement; Chronic Pain; Analgesia, Epidural; Clinic, Pain Interventions: Procedure: Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.; Procedure: Fluoroscopically guided lumbar facet joint injection.; Procedure: Fluoroscopically guided lumbar epidural corticosteroid injection.; Procedure: Fluoroscopically guided caudal epidural c orticosteroid injection.; Procedure: Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.; Procedu...
AbstractPurposeEvaluation of clinical and radiological effects of the therapeutic outcome of CT-guided pulsed radiofrequency (PRF) treatment adjacent to the lumbar dorsal root ganglion (DRG) for patients with chronic intractable lumbosacral radicular pain in a single-center prospective longitudinal study in order to evaluate predictive factors of safety and therapeutic success.Materials and methodsThirty patients, from 2016 to 2018, were enrolled (age: 42 –80 aa, 66.7% men and 33.3% females) with low back pain, lumbosciatalgia and/or lumbocruralgia, resistant to previous medical and physical treatments for a period not
We present the case of a 48-year old male patient with chronic motor complete SCI, who benefited from a 5-day period of bilateral L2-level DRG-stimulation by experiencing suppression of transfer-evoked spasticity problems and of chronic lower back pain. To the best of our knowledge, this is the first case describing the successful application of DRG-stimulation for spasticity depression in patients with chronic SCI.
ConclusionsT12 DRG ‐S can be an effective treatment for chronic axial low back pain. Stimulation results in reduced pain and disability, while improving quality of life. These outcomes can be achieved without paresthesias.
Conclusions: In summary, our studies provide initial evidence that the LDH chronic pain model might serve as a model of the comorbidity of low back pain and depression. The finding that FLX improved depressive behavior and pain through normalized 5-HT concentrations and TNF-α mRNA expression establishes the initial mechanism of the comorbidity of pain and depression.
IntroductionDisruptions of lumbar intervertebral discs may lead to severe discogenic low back pain (LBP). Severe pain has a deleterious effect on physical function and quality of life. Spinal cord stimulation (SCS) is a robust treatment for many neuropathic pain conditions. New innovations may be well ‐suited to treat neuropathic chronic LBP, including discogenic pain. The aim of this prospective study was to determine the effect of dorsal root ganglion (DRG) stimulation for a well‐selected group of patients with discogenic LBP with no history of previous back surgeries.MethodsTwenty subjects with confirmed discogenic ...
Acta Anaesthesiologica Scandinavica, EarlyView.
ConclusionsIncluding the above-listed items in the patient history might facilitate differentiation of low back pain and sciatica due to STCs from that due to disc problems or degenerative or inflammatory disorders.