The most common neuromodulation procedures performed are spinal cord stimulation (SCS) and dorsal root ganglion (DRG) stimulation.
Spinal cord stimulation
SCS works by “closing the gate” of the pain signals that travel from the spinal cord to the brain. There is also evidence pointing toward change of the local chemistry, which can lead to decreased pain perception. The DRG is a bundle of sensory nerve bodies that receives pain signals from a specific body region. Therefore, applying stimulation to the DRG can aid in blocking signals perceived by the brain. They are used for treating pain in a nerve region that is not accessible by spinal cord stimulation.
There are two main parts to the stimulation device: the leads and the battery. The battery is the power source that causes the stimulation to the spinal cord or DRG, and the leads are the part of the system that sends the stimulation signals to specific targeted areas.
SCS and DRG procedures come in two stages: the trial phase and the implantation phase. The trial phase is a period of time (usually seven days) that allows the patient to try out the stimulation device to see if adequate pain relief can be achieved.
During the trial phase, the leads are sterilely placed into the epidural space behind the spinal cord for SCS or at the dorsal root ganglion for DRG. The battery, however, is secured with extensive taping on the outside of the body. After the procedure, you will have the opportunity to work with a representative from the device company in identifying the program setting that gives you the best pain relief and function.
You will follow up in our clinic after one week and, if adequate pain relief and/or function is achieved, then you have the option to proceed with the implantation procedure.
The permanent implantation procedure is performed in an operating room setting, and the battery will be surgically placed under the skin, usually in the lower back either above or below the belt line. The leads are placed in a similar fashion to the trial phase; however, no parts of the leads will be visible outside of the body.
There are a few steps that will need to be achieved prior to undergoing the trial phase. Those include: approval by your insurance company, psychological clearance by our pain psychologist and an updated MRI of the lumbar and thoracic spine within one year (physician discretion) of the procedure.
Dorsal root ganglion stimulation
Dorsal root ganglion (DRG) stimulation is a management option for very localized neuropathic (nerve-related) pain. The DRG helps send sensory information from peripheral nerves to the central nervous system. In patients with neuropathic (nerve-related) pain, the DRG becomes altered and sends inappropriate signals to the central nervous system, and patients feel those inappropriate signals as neuropathic pain.
By placing a small electrical wire (lead) near the DRG, we can change the way the DRG behaves and significantly relieve neuropathic pain.
A few indications for dorsal root ganglion stimulation include post-amputation pain, complex regional pain syndrome, post-total knee arthroplasty pain and ilioinguinal neuralgia.
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