• Adnan Al-Kaisy, Jonathan Royds, Matteo Costanzi, Gabor Racz, Samuel Wesley, Stefano Palmisani, David Pang, and Thomas Yearwood.
• Guys and St. Thomas NHS Foundation Trust, London, United Kingdom.
• Pain Physician. 2019 Nov 1; 22 (6): 601-611.

BackgroundThe recent interest in targeting the dorsal root ganglion (DRG) has led to the development of new techniques of electrode placement. In this article, we describe a new "Transgrade" approach to the DRG, accessing the contralateral interlaminar space and steering the lead out the opposite foramen.ObjectivesThe purpose of this study was to evaluate the Transgrade technique to the DRG in the management of focal neuropathic pain, predominately complex regional pain syndrome in terms of efficacy and safety.Study DesignA retrospective, observational review of all patients selected for DRG stimulation using the Transgrade technique to the DRG.SettingPain Management and Neuromodulation Centre, Guys and St. Thomas NHS Foundation Trust, London, United Kingdom.MethodsData were taken from a hospital password-protected database. All patients were contacted by telephone for Numeric Rating Scale (NRS-11) score, Patient Global Impression of Change (PGIC) score, and complications. A patient responder was defined as having a PGIC score of 6 or 7, and a 2-point reduction from baseline NRS-11.ResultsA total of 39 patients (46% women) with a mean age of 46 years (± 2) underwent a trial of DRG stimulation that resulted in an implantation rate of 82% (32 of 39). The responder rates, according to NRS-11 and PGIC results, were 87% (28 of 32) at 6 weeks and 66% (21 of 32) at a mean of 18 months (± 1.8) follow-up. Pocket pain was the most common complication, occurring in 7 of 32 (22%) patients, and the lead migration rate was 3 out of 57 leads placed (5.2%). A burst protocol was the favored method of stimulation in the majority of patients, 25 of 32 (78%).LimitationsRetrospective nature of design, small sample size.ConclusionsThe Transgrade technique of placing DRG leads offers an alternative method that is safe and effective. New methods of stimulation to the DRG offer more choice and potentially better efficacy for patients with chronic neuropathic pain.Key WordsNeuromodulation, dorsal root ganglion, neuropathic pain, complex regional pain syndrome, spinal cord stimulation, chronic pain, implantable neurostimulators, spinal nerve root stimulation.

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