Journal of Pain Research (Dec 2020)
An Observational Study of Intraoperative Neuromonitoring as a Safety Mechanism in Placement of Percutaneous Dorsal Root Ganglion Stimulation and Spinal Cord Stimulation Systems
Abstract
Jonathan M Hagedorn,1 Timothy R Deer,2 Steven M Falowski,3 Abhishek Yadav,4 Ashley Comer,2 Zayd Al-Asadi,5 Alyson M Engle2 1Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA; 2The Spine and Nerve Center of the Virginias, Charleston, WV, USA; 3Argires-Marotti Neurosurgical Associates of Lancaster, Lancaster, PA, USA; 4Department of Anesthesiology and Perioperative Medicine, Brown University, Providence, RI, USA; 5University of South Florida, Tampa, FL, USACorrespondence: Timothy R Deer Email [email protected]: Percutaneous neurostimulator device placement, specifically dorsal root ganglion (DRG) stimulation and spinal cord stimulation (SCS), involves the placement of thin wires within the spinal canal at specific locations, the DRG or dorsal column of the spinal cord, respectively, to provide an electrical current that modifies the pain signal as it enters the central nervous system from the periphery. Placement of neurostimulator devices is generally safe overall, but not without risk of major and minor complications. In this study, we assess the use of intraoperative neuromonitoring (IONM) as a tool to improve the safety of placing neurostimulator devices and subsequently minimizing postoperative complications.Methods: After IRB approval, an observational study was performed in 115 procedures to evaluate safety during placement of both temporary and permanent DRG and SCS systems and to document retrospectively any long-standing adverse events.Results: The rate of intraoperative neuromonitoring abnormal activity was 1.7% (n = 2), which allowed prompt recognition of nerve irritation and lead repositioning. Of the 115 consecutive implant cases performed with IONM, the postoperative minor adverse event rate was 1.7% (n = 2), which were transient and corrected with reprogramming. There were no long-standing neurological complications.Conclusion: In the largest observational study to date, we show that IONM creates a safe environment for patients undergoing SCS and DRG neurostimulator placement with the potential to decrease neurological complication rates. The use of IONM may be an alternative method to improve patient safety and outcomes as compared to monitor anesthesia care.Keywords: dorsal root ganglion, spinal cord stimulation, intraoperative neuromonitoring, safety, complications
