Dorsal Root Ganglion Stimulation versus Dorsal Column Stimulation for Relief of Axial Back Pain

Introduction: Dorsal root ganglion stimulation has been recognized to play a role in complex regional pain syndrome, however, recent studies suggest this stimulation may have value in treating patients with predominantly axial back pain. The efficacy of dorsal root ganglion stimulation in the treatment of axial back pain and comparison with traditional tonic dorsal column stimulation and the more recent higher frequency dorsal column stimulation systems, such as burst remains undefined.

Methods: Ten consecutive patients presenting with recalcitrant predominantly axial back pain (at least 90% of pain localized to the lower back) were offered a dual percutaneous trial of both dorsal column stimulation, testing both tonic and burst stimulation, and bilateral T12 dorsal root ganglion stimulation. Results of dorsal column stimulation compared with dorsal root ganglion stimulation in the relief of back pain were collected, including visual analog scores, percentage self-described pain relief, and modified Oswestry disability scores, after a trial period of 7-10 days. A permanent implant was then installed for the system deemed most effective and patients were followed at 1 month and 3 month intervals.

Results: Of the 10 patients enrolled, 8 responded with better relief with dorsal root ganglion stimulation. One patient elected dorsal column (burst) stimulation, although that patient responded equally well with both systems, reporting a 70% reduction in pain with both systems, however, reporting her radicular pain responded better to the dorsal column stimulator system and, therefore, choosing that implant. No patients responded better with tonic stimulation. One patient obtained marginal relief with both systems (40% reduction in pain with both the dorsal column and dorsal root ganglion systems) and did not elect to proceed with a permanent implant. In addition, average pain relief by visual analog scores, percentage pain relief, and improvement in modified Oswestry scores were better with dorsal root ganglion stimulation compared with dorsal column stimulation.

Conclusion : Bilateral T12 dorsal root ganglion stimulation can be an effective treatment for chronic axial back pain and may offer better results than dorsal column stimulation.