• Sean Martin, George Hadjipavlou, Garcia Ortega Rodrigo R Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK., Liz Moir, Tamara Edwards, Stana Bojanic, Alexander L Green, and James J FitzGerald.
• Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
• Neuromodulation. 2020 Feb 1; 23 (2): 245-251.

ObjectiveTo quantify the relationship between the electrical power requirement to achieve pain relief and the position of the active electrode of dorsal root ganglion stimulators within the spinal nerve root exit foramen.Materials And MethodsRetrospective analysis of prospectively collected data of 92 consecutive patients undergoing dorsal root ganglion stimulation (DRGS) for chronic pain in a single center. Cervical and sacral cases, and failed trials/explanted DRGS were excluded, so we report on 57 patients with 78 implanted leads. Anteroposterior and lateral fluoroscopic images of the lead in the exit foramen were examined, and the active electrode positions were put into categories depending on their location relative to fixed anatomical landmarks. The clinical outcome and the power requirements for each of these groups of electrodes were then analyzed. Overall pain outcome was assessed by numeric pain rating scale score pre-operatively and post-operatively.ResultsThere was no significant relationship between power requirements and mediolateral electrode position, although the lowest average was observed with electrode positions directly below the center of the pedicle. On lateral x-ray, the lowest power requirements were observed in the electrodes positioned superodorsally or dorsally within the foramen. Importantly, power requirements in this location were consistently low, while the power requirements in other locations were not only higher but also much more variable. Electrodes in the superodorsal position required a median output power almost four times lower than electrodes in other positions (p = 0.002). Clinical outcome was not significantly related to power requirement or foraminal position.ConclusionAiming for a superodorsal electrode position on lateral intraoperative fluoroscopy is desirable, since siting leads in this location reduces the required stimulator output power very substantially and thus will extend battery life. Position within the foramen does not determine clinical outcome, and so the implanter can safely aim for the low power site without detriment to the analgesic efficacy of the system.© 2019 International Neuromodulation Society.

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