Outcomes in Open Implantation of Dorsal Root Ganglion Stimulators From a Single Surgeon

Introduction: Dorsal root ganglion (DRG) stimulators are implanted to manage intractable chronic pain. However, lead migration remains a prevalent complication for percutaneously-placed DRG leads, even with use of strain-relief loop techniques. Open surgical implantation allows for better fixation of the leads to surrounding anatomy, preventing migration and the need for revision. We present a 20-patient case series on open DRG placement, the largest case series on this technique to date.

Methods: After obtaining IRB exemption, a retrospective review was completed from a prospective database of 20 patients who had undergone an open surgical approach for placement of DRG leads by a single surgeon between October 2021 and October 2023. Descriptive statistics were obtained, such as age, sex, BMI, and level(s) of implantation. Phone interviews were conducted to determine post-operative outcomes.

Results: We identified 20 patients (14 women, 6 men) who underwent lead placement ranging from L1-S2. There were no infections, hematomas, or symptomatic lead migrations. 1/20 patients had a subclinical lead migration which was related to spondylolisthesis from a trauma. 2/20 experienced a superficial dehiscence which did not require operative revision and 2/20 had an intra-operative durotomy. Phone interviews were conducted for 10/20 patients, with average follow-up of 11.9 months (range 1.6-25.4 months). 8/10 patients experienced pain relief, improved quality of life, and were satisfied with their DRG device. The mean pre-op pain score was 8.9±1.2, and the mean post-op pain score was 4.2±2.9 (n=10, p< 0.001). 6/10 patients required less pain medication after open DRG implantation.

Conclusion : Open DRG placement has minimal complications intraoperatively and postoperatively. Our preliminary experience shows this technique can reduce the rate of migration seen with percutaneous techniques. Neurosurgical placement of these devices is a valid option which should be offered to patients seeking treatment for intractable chronic pain. Further work can demonstrate long-term benefits of the proposed surgical approach.