EFFICACY OF DORSAL ROOT GANGLION STIMULATION AFTER FAILURE OF SPINAL CORD STIMULATION IN PERSISTENT SPINAL PAIN SYNDROME TYPE 2: A CASE REPORT

S. Zappalà¹, S. Stimolo¹, G. Ruggieri¹, A. Spina², S. Caramma¹ | ¹Pain Center, Catania; ²Anesthesiology and Resuscitation, “G. Rodolico-S. Marco” University Hospital, Catania

INTRODUCTION
Persistent Spinal Pain Syndrome type 2 (PSPS2), previously referred to as Failed Back Surgery Syndrome (FBSS), is a challenging and disabling condition affecting patients with chronic pain that is caused or worsened by spinal surgery. In cases where conventional Spinal Cord Stimulation (SCS) fails, Dorsal Root Ganglion Stimulation (DRG-S) offers a more targeted and potentially more effective approach, directly modulating the sensory neurons responsible for pain transmission.
METHODS
The patient was a 56-year-old male with PSPS2 and right-sided L5-S1 radiculopathy. He had previously undergone microdiscectomy, L4-L5 spinal fusion, and two failed SCS trials (conventional and high-frequency). In 2025, at the UOSD pain therapy of the San Marco Hospital in Catania he was selected for DRG-S implantation at the right L5-S1 level. During a 10-day trial at 20 Hz, the patient experienced >50% pain relief. After a short washout, stimulation was reduced to 4 Hz with increased clinical benefit. Assessments were carried out at T0 (pre-op), T1 (1 month), T2 (3 months), and T3 (6 months), using the Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), Patient Global Impression of Change (PGIC), and Short Form Health Survey (SF-12, PCS and MCS).
RESULTS
The patient’s pain level decreased from NRS 9 to 3, ODI improved from 70% to 20%, and PGIC reached 70%. SF-12 scores also improved markedly: PCS-12 from 19.6 to 34.7, and MCS-12 from 36.6 to 45.6. All improvements remained stable through the six-month follow-up, even with low-frequency stimulation, suggesting consistent therapeutic benefit.
CONCLUSIONS DRG-S proved effective as a rescue therapy for PSPS2 with associated radiculopathy, resulting in sustained pain relief and functional improvement. Its localized mechanism offers potential advantages over traditional SCS. Larger prospective studies with longer follow-up are needed to confirm and expand upon these promising findings.