Disclosures: Shrina Parekh: No financial relationships or conflicts of interest

Case Description: Patient has past medical history of L2-5 pedicle screw fixation, L3-4 revision laminectomy, L3-4 posterior lumbar interbody fusion, and is status post failed paddle dorsal column stimulator at T8-10 in 2018.
Patient reported worsening primarily lower lumbar axial back pain that remains constant, aching, and is most noticeable with activity.
Given patient’s surgical history and primarily axial back complaints, patient underwent a dorsal root ganglion (DRG) stimulator trial over bilateral T12 DRGs. Patient was given IV antibiotics prior to initiating the procedure. A #14-gauge Touhy needle was advanced under fluoroscopic guidance into the epidural space until loss of resistance was obtained. At that time an epidurally placed DRG stimulation sheath was advanced under fluoroscopic guidance to the T12 exiting DRG on the left. Once positioned, the guide wire was removed. The lead was advanced through the sheath and the sheath was carefully withdrawn and strain relief loops placed in the epidural space. The second lead was placed in the same manner over the right T12 DRG.

Setting: Outpatient Neuroscience and Spine Clinic

Patient: A 64-year-old male with chronic axial low back pain.

Assessment/Results: At follow up status post DRG stimulator trial, patient reported >65% benefit. He further reported his sleep was improved as well as his quality of life. He thereafter underwent bilateral T12 DRG implantation procedure with good benefit.

Discussion: This is a unique case of a successful bilateral T12 DRG stimulation for chronic axial back pain in a patient with failed dorsal column paddle spinal cord stimulator and L2-5 lumbar fusion.

Conclusion: Bilateral T12 DRG stimulation was shown to be a novel and optimal choice to control axial back pain and improve quality of life. Additionally, it may become first line for patients with previously unsuccessful lower lumbar fusions and/or dorsal column stimulators due to anatomical considerations.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/implantation-of-dorsal-root-ganglion-stimulator-after-failed-dorsal-column-spinal-cord-stimulation-in-a-male-with-chronic-axial-low-back-pain-a-case-report/