•Focal neuropathic pain syndromes with identified pathology

•A cluster of sensory cell bodies that transmits input from the PNS to CNS

•location makes it amenable to epidural access techniques

•identified radiologically as lying at the caudal aspect of the neuroforamen between the pedicles on the AP view and posterior to posterior portion of the vertebral body

 

 

In some instances, the DRG lead cannot pass through a neuroforamen due to some anatomical barrier. In the past, the level above or below was targeted with the hope that there is coverage due to nerve root overlap. This can provide some relief, but it is not directly targeting the nerve root of interest. In this case report, we present a case of a patient with a sacralized L5 and successful extraforaminal DRG stimulation.

Lead placement for dorsal root ganglion stimulation using an extraforaminal approach

 

Results:

 

One week after procedure, patient reported:

 

Discussion:

 

Anatomical barriers and previous surgeries can preclude practitioners from using the traditional anterograde approach for DRG stimulation. In this case report, we illustrate a patient with a sacralized L5 who had successful trial lead placed with a sacral and extraforaminal approach. This is a promising technique which can help providers with DRG stimulation for patients who have a sacralized L5 vertebral body.