Effectiveness of combined dorsal root ganglion and spinal cord stimulation: a retrospective, single-centre case series for chronic focal neuropathic pain

Abstract

Objective: This case series retrospectively reviewed the outcomes in patients implanted with combined, synchronous dorsal root ganglion stimulation (DRGS) and spinal cord stimulation (SCS) connected to a single implantable pulse generator (IPG) in a tertiary referral neuromodulation centre in the United Kingdom. Methods: Twenty-six patients underwent a trial of DRGSþSCS for treating focal neuropathic pain between January 2016 and December 2019, with a follow-up in February 2022. A Transgrade approach was employed for DRGS. Patients were provided with 3 possible stimulation programs: DRGS-only, SCS-only, or DRGSþSCS. Patients were assessed for pain intensity, patients’ global impression of change (PGIC), preferred lead(s) and complications. Results: Twenty patients were successful and went on for full implantation. The most common diagnosis was Complex Regional Pain Syndrome. After an average of 3.1 years follow-up, 1 patient was lost to follow-up, and 2 were non-responders. Of the remaining 17 patients, 16 (94%) continued to report a PGIC of 7. The average pain intensity at Baseline was 8.5 on an NRS scale of 0–10. At the last follow-up, the average NRS reduction overall was 78.9% with no statistical difference between those preferring DRGSþSCS (n ¼ 9), SCS-only (n ¼ 3) and DRGS-only (n ¼ 5). The combination of DRGSþSCS was preferred by 53% at the last follow-up. There were no serious neurological complications. Conclusions: This retrospective case series demonstrates the potential effectiveness of combined DRGSþSCS with sustained analgesia observed at an average follow-up of over 3 years. Implanting combined DRGSþSCS may provide programming flexibility and therapeutic alternatives.