Background and Aims
Chronic neuropathic pain syndromes of the lower extremities might occur or develop of different origin or diseases. In cases of refractory pain to conservative, pharmacological or multimodal treatment options, invasive neuromodulation might be considered. Spinal cord stimulation (SCS) is available for many decades, but European experience with dorsal root ganglion stimulation (DRGS) is limited. Patient cohorts with SCS and DRGS and chronic neuropathic pain of the lower extremities are presented.
Methods
Indication for invasive neuromodulation was debated in patients with refractory pain syndromes of the lower extremities and high pain intensities, concomitant with high doses of pain related medications. Patients were selected considering pain after spinal procedures (e. g. failed lumbar back surgery syndrome, FBSS) or peripheral nerve lesions. In all patients lead implantation was followed by a test–trial of one week with an external stimulation device.
Results
A total number of 110 patients were selected from 2013 to 2018. SCS was implanted in 90, DRGS in 20 patients. During the test trial a significant pain reduction was observed in 82/90 (91%), respectively 19/20 (95%) patients and withdrawal of analgesics was initiated. In all responders a permanent stimulation device was implanted.
Conclusions
The clinical results of strictly selected patients undergoing SCS or DRGS are very encouraging. DRGS was preferred for patients with pain following inguinal repair, knee-procedures or CRPS of the foot. The main indication for SCS was FBSS with predominant neuropathic leg pain. Restrictions regarding the full-body MRI-conditionality of the DRGS devices must be respected.

INVASIVE NEUROMODULATION OF THE SPINAL CORD OR DORSAL ROOT GANGLION IN CHRONIC NEUROPATHIC PAIN SYNDROMES OF THE LOWER EXTREMITIES