What is Dorsal Root Ganglion (DRG)?
DRG Stimulation: A Clinically Proven Therapy Epidurolysis : Dorsal Root Ganglion (DRG) is a bundle of nerves located outside the spinal cord. These nerves are located along the spinal column; they send sensations and signals through nerve fibers to the brain.
The brain has quite a number of DRG located at specific parts of the body. DRG plays a vital role in reducing nerve pains confirmed to come from nerve injuries (Causalgia) or Reflex Sympathetic Dystrophy Syndrome (RSDS).
DRG Stimulation is a new technology that aims at stimulating the DRG region which in turn relieves chronic pain. DRG stimulation is targeted to the specific area of pain and has proven to be more effective than traditional Spinal Cord Stimulation (SCS). Basically, DRG stimulation is to inject the DRG with electrical pulses which hinders pain signals from getting to the brain.
Why DRG is preferred over SCS?
- DRG is better for smaller and specific areas of pain
- It has proven to be an effective means of relieving nerve damages
- DRG has a reduced side effect compared to SCS.
- The stimulator in DRG only stimulates the DRG and not the spinal cord.
When is DRG therapy required?
- Pain must have continued for many months despite the use of pain relievers.
- When other forms of therapies are not yielding results.
- When one feels pains in specific and small regions such as groins, hips, lower feet, etc.
- When one experiences chronic pains in specific areas after surgery or nerve block.
What makes up a DRG Stimulator?
1. Electrical Leads
The leads are thin insulated wires threaded carefully in the epidural space. The leads are connected to a generator, the generator creates mild electrical pulses and it is transferred to the DRG through the leads. The leads are tipped by a number of contacts that are placed in the DRG region. They are powered by the batteries in the generator.
A small device serves as the generator which is implanted alongside the leads. The generator discharges electrical pulses to the DRG region. The generator is planted at the upper buttocks or low back and is powered by a non-rechargeable battery.
This is a small device like a remote control that helps patients change stimulation settings or turns the generator off. Patients are taught how to use the controller to change stimulation levels to counter the chronic pains they are experiencing.
What are the methods of DRG Stimulation?
This is a temporary and quick way of undergoing DRG therapy. In a pre-test, the leads are injected into the DRG through an epidural needle but connected to a stimulator outside the body. Patients are able to control the stimulator to their comfort. After this procedure, the leads are removed when the pains must have subsided. This method is best when chronic pain happens occasionally.
This method requires that the generator and leads are implanted into the body for a long period of time and replaced every 2 to 5 years. This is done under conscious sedation and the consent of the patient. The leads are implanted in the DRG region around the spinal cord while the generator is implanted around the abdomen region. A controller is also given to the patient to control the stimulation level or turn it off.
Who uses DRG Stimulator?
DRG stimulation is mostly used in cases of chronic pains that have lasted more than 6 months. Infections and accidents can cause pains and discomfort but the pains do not continue for a long period time if treated. Chronic pains in this context usually originate from nervous system malfunction or defect and are most times corrected by physical therapy, nerve blocks or surgery.
Common signs of Chronic Pains are:
- Prolonged sharp pains
- Needle sensations
- Insensitive to touch
- Freezing and hot feeling
- Muscles weakness
The pains are usually in areas where traditional SCS will not handle properly. The regions include the hand, chest, abdomen, foot, knee and groin regions.
What are the effects of DRG Therapy?
- Patients who responded well to DRG stimulation reported that they have a reduced discomfort and pains over time.
- Just like every surgery; bleeding, pains and infection may occur around the surgical site. Full recovery can take close to 2 weeks.
- Patients also do not feel any tingling sensation or pricking as they would have experienced during Spinal Cord Stimulation.
- In adverse events, it can cause an injury to the nerves in the DRG region and could lead to paralysis.