게시판
| 21KS-022 |
Dorsal root ganglion stimulation combined with spinal cord stimulation for effective treatment of postherpetic neuralgia
Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul
Introduction
Postherpetic neuralgia (PHN) is most common complication following herpes zoster. PHN often results in a chronic severe pain. Although spinal cord stimulation (SCS) can be treatment option for intractable PHN, it is difficult to obtain proper stimulation. Dorsal root ganglion (DRG) stimulation combined with SCS may be an effective treatment for patient with insufficient efficacy in SCS only. We stimulate thoracic DRG stimulation combined with SCS for intractable PHN and get good result.
Case report
We obtained written informed consent from the patient to publish this report. A 54 years old man with PHN was referred to our clinic. Pain was localized to the left axilla and left upper arm in the distribution of T1-3 dermatome. He received medical therapy and interventional therapy with epidural block, nerve root block and radiofrequency treatment several times. However, he got pain relief not at all or just had a short term effect. Therefore, we decided SCS trial. SCS trial was conducted and lead was placed within the epidural space over C6 upper border, however stimulation is inadequate. Therefore, another leads were placed within Left T1, T2 DRG for trial and T1 DRG stimulation provided adequate stimulation(Fig. 1). For 1 week of trial periods, his pain was relieved more than 50% (pain score 9-10 => 4). DRG stimulation combined with SCS could stimulate almost his pain lesion include his most severe pain site. The stimulator worked properly during hospitalization and had no complications. He was discharged from the hospital in two weeks. After 2 months, his pain score was 3-4 and the DRG stimulation with SCS was effective.
Conclusion
DRG stimulation combined with SCS may be treatment option for intractable PHN without significant complications and inconvenience. DRG stimulation may compensate for the shortcomings of spinal cord stimulation which is difficult to stimulate at specific thoracic dermatome.
Postherpetic neuralgia (PHN) is most common complication following herpes zoster. PHN often results in a chronic severe pain. Although spinal cord stimulation (SCS) can be treatment option for intractable PHN, it is difficult to obtain proper stimulation. Dorsal root ganglion (DRG) stimulation combined with SCS may be an effective treatment for patient with insufficient efficacy in SCS only. We stimulate thoracic DRG stimulation combined with SCS for intractable PHN and get good result.
Case report
We obtained written informed consent from the patient to publish this report. A 54 years old man with PHN was referred to our clinic. Pain was localized to the left axilla and left upper arm in the distribution of T1-3 dermatome. He received medical therapy and interventional therapy with epidural block, nerve root block and radiofrequency treatment several times. However, he got pain relief not at all or just had a short term effect. Therefore, we decided SCS trial. SCS trial was conducted and lead was placed within the epidural space over C6 upper border, however stimulation is inadequate. Therefore, another leads were placed within Left T1, T2 DRG for trial and T1 DRG stimulation provided adequate stimulation(Fig. 1). For 1 week of trial periods, his pain was relieved more than 50% (pain score 9-10 => 4). DRG stimulation combined with SCS could stimulate almost his pain lesion include his most severe pain site. The stimulator worked properly during hospitalization and had no complications. He was discharged from the hospital in two weeks. After 2 months, his pain score was 3-4 and the DRG stimulation with SCS was effective.
Conclusion
DRG stimulation combined with SCS may be treatment option for intractable PHN without significant complications and inconvenience. DRG stimulation may compensate for the shortcomings of spinal cord stimulation which is difficult to stimulate at specific thoracic dermatome.
