An Anatomy-Informed, Novel Technique for S1 Dorsal Root Ganglion Stimulation Lead Placement

Kenneth B Chapman; Noud van Helmond; Jan Willem Kallewaard; Kris C Vissers; Kiran V Patel; Soriaya Motivala; Jonathan M Hagedorn; Timothy R Deer; David M Dickerson

doi:10.1093/pm/pnac062

An Anatomy-Informed, Novel Technique for S1 Dorsal Root Ganglion Stimulation Lead Placement

Pain Med. 2022 Sep 30;23(10):1750-1756. doi: 10.1093/pm/pnac062.

Authors

Kenneth B Chapman^{1

2

3

4}, Noud van Helmond^{1

4}, Jan Willem Kallewaard⁵, Kris C Vissers⁴, Kiran V Patel^{1

2

3}, Soriaya Motivala⁶, Jonathan M Hagedorn⁷, Timothy R Deer⁸, David M Dickerson^{9

10}

Affiliations

¹ The Spine & Pain Institute of New York, New York, New York, USA.
² Department of Anesthesiology, NYU Langone Medical Center, New York, New York, USA.
³ Department of Anesthesiology, Northwell Health, New York, New York, USA.
⁴ Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
⁵ Department of Anesthesiology, Rijnstate Ziekenhuis, Velp, The Netherlands.
⁶ Department of Neurosurgery, Northwell Health, New York, New York, USA.
⁷ iSpine Pain Physicians, Maple Grove, Minnesota, USA.
⁸ The Spine and Nerve Center of the Virginias, Charleston, West Virginia, USA.
⁹ Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University Health System, Evanston, Illinois, USA.
¹⁰ Department of Anesthesia & Critical Care, University of Chicago, Chicago, Illinois, USA.

Abstract

Objective: A heightened and organized understanding of sacral anatomy could potentially lead to a more effective and safe method of dorsal root ganglion stimulation (DRG-S) lead placement. The aim of this technical note is to describe a standardized access method for S1 DRG-S lead placement.

Design: Technical note.

Methods: The described approach utilizes alignment of the lumbosacral prominence and is measurement-based, allowing for standardized sacral access, even when visualization is suboptimal. The medial-to-lateral needle trajectory is designed to limit interaction with the sensitive neural structures and allows for a more parallel orientation of the lead to the DRG and nerve root.

Conclusions: The described technique potentially improves the safety of S1 DRG-S lead placement. The parallel lead orientation to the DRG may also increase efficacy while lowering energy requirements.

Keywords: Dorsal Root Ganglion Stimulation; Neurostimulation; Sacral Nerve; Safety; Technique.

MeSH terms

Ganglia, Spinal* / physiology
Humans
Lumbosacral Region
Sacrum
Spinal Cord Stimulation* / methods