Abstract
Extraforaminal spinal nerve stimulation (SNS) is an emerging neuromodulation technique for treating neuropathic pain. Targeting the spinal nerve distal to the intervertebral foramen enables anatomically precise stimulation, distinguishing it from conventional spinal cord or dorsal root ganglion stimulation. This article provides the first comprehensive description of the extraforaminal SNS approach, including technical refinements, anatomical insights, and clinical experience. Key procedural steps include identifying anatomical landmarks, intraoperative stimulation strategies, and lead placement guidance. A central feature of the technique is using intraoperative motor stimulation to confirm accurate lead positioning, evidenced by visible, low-threshold muscle contractions. Tonic stimulation was employed to assess dermatomal coverage. Stimulation was applied intraoperatively and postoperatively to guide and confirm lead positioning. Two modified anchoring techniques were developed and implemented to address the challenge of lead migration; since their adoption, no further cases of lead dislocation have been observed. The described approach has proven safe, feasible, reproducible, and effective in clinical practice. Extraforaminal SNS offers a focused, segment-specific neuromodulation strategy for patients with localized dermatomal pain in the lower extremity, particularly for those with contraindications to conventional neurostimulation modalities. Its advantages include a shallow learning curve, precise anatomical targeting, reliable intraoperative stimulation, and improved long-term lead stability through robust conventional spinal cord stimulation systems combined with optimized anchoring techniques. These characteristics support its growing clinical relevance as a technically straightforward and effective alternative to traditional stimulation methods in selected patient populations. This article provides detailed guidance on the successful implementation of this technique for the treatment of therapy-resistant neuropathic pain.
Keywords
Extraforaminal spinal nerve stimulation, Neuromodulation, Chronic neuropathic pain, Peripheral nerve stimulation