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What is spinal cord stimulation?
A spinal cord stimulator is a neuromodulation device surgically implanted under your skin. The device sends mild electric electrical pulses to the nerve fibres in the spinal cord to manage chronic pain which is termed as spinal cord stimulation (SCS). Eventually, it helps to reduce the use of opioid medications. The electric pulse released from the stimulus masks the pain signals before they reach the brain.

It is an option for people suffering from chronic back pain, leg pain or arm pain who have not found relief from pain with other therapies. Stimulation will not eliminate the source that causes pain; it just interferes with the pain signals and modifies them before sent to the brain. Nearly 50-70% of pain can be reduced with the help of spinal cord stimulation.

What is Dorsal Root Ganglion Stimulation?
A dorsal root ganglion or spinal ganglion is a cluster of nerves in a dorsal root which sends signals to the brain. In simple words, dorsal root ganglion structures act like traffic signal lights, managing the signals and sensations travelling through the nerve fibres beside the spinal column to your brain. It is connected to every vertebra in the spinal cord.

Dorsal root ganglion (DRG) stimulation therapy is an innovative procedure designed to manage chronic pain which is difficult-to-treat in specific areas. DRG stimulation device is implanted in the spinal area under your skin. This device generates mild electric impulse and delivers DRG area in your spine. The stimulation can manage the DRG in such a way that it blocks the pain signals from reaching the brain. The stimulation helps to create a comfortable tingling sensation where you have pain or can completely stop the feeling of pain.

What Is Complex Regional Pain Syndrome?
Complex regional pain syndrome (CRPS) is a chronic condition of pain which mostly affect arm, leg, hand or foot after an injury. It is believed that CRPS is caused by damage to peripheral and central nervous systems. The central nervous system comprises the brain and the spinal cord. The peripheral nervous system is responsible for transferring signals from your brain and spinal cord to other body parts. CRPS might be one of the causes for (contracture)shrinkage of muscles in patients with spinal cord injury.

Though chronic pain is one of the symptoms of spinal cord injury; CRPS is relatively rare, and nearly 5–10% of people with spinal cord injury may experience this condition. CRPS is defined by prolonged or excessive pain and changes in skin colour, temperature, and swelling in the affected area.

How does DRG differ from Spinal cord stimulation?
A Spinal Cord Stimulation (SCS) or Dorsal Column Stimulation (DCS) is a process of implanting neuromodulation device (similar to a pacemaker) to send electrical impulses to specific areas of the spinal cord for the management of certain pain conditions. The main difference between DRG and SCS is the type of fibre activation associated with these stimulation types. SCS involved in the stimulation of the dorsal columns by producing broad electrical stimulation. But DRG stimulation is more accurate, directly targets the cell bodies that associate with the painful regions.

Experts conducted a study on CRPS patients for 12 months comparing DRG stimulation to SCS stimulation, the results found to be:

  • Some patients got 74% pain relief with DRG stimulation compared to SCS with 53% pain relief
  • 95% of patients reported better pain relief with DRG and 61% with SCS
  • However, more than 33% of patients experienced 80% pain relief and felt better.

The main advantage of DRG stimulation is the ability to treat specific areas which can’t be effectively treated with SCS – spinal cord stimulation. In cases, when SCS is not suitable, DRG stimulation might be an important alternative for pain reduction.

What is the role of DRS OR SCS for treating a patient with spinal ailments?
The role of spinal cord stimulation or dorsal root stimulation is to treat patients suffering from certain painful conditions which have failed to manage the pain with conservative or Surgical management, including physical therapy. Many times these are used in cases which have had multiple failed back surgeries . Spinal cord stimulation (SCS) is a well-established stimulation therapy for complex regional pain syndrome(CRPS) and failed back surgery syndrome(FBSS) which is widely accepted in terms of safety and efficiency. It can also help the pain reduction after surgery.

How are the results?
Both spinal cord stimulation (SCS) and DRG stimulation are performed in a two-step process, one is the trial basis, and the other is permanent. DRG or SCS is permanently implanted when the trial is successful, i.e. pain reduction should be at least 50% or more, then it may be implanted permanently.

The process may not cure the pain, but the results are precise in pain reduction for both procedures with a high success rate. However, the result of pain reduction varies from person to person. Many people experience more than 50% reduction in pain, and 80% of your pain area is covered with a comfortable sensation. Around 80 out of every 100 people respond to either SCS or DRG stimulation procedure.

A small amount of energy is sufficient to alter the pain signals in the dorsal root so that these devices can maintain working for an extended period of time in your body on limited battery power. For more information and to find out if you are the candidate for these DRG or SCS stimulation therapies, consult Dr Surya Prakash Voleti, a spine surgeon in Hyderabad.