• Ezequiel Goldschmidt, Wendy Fellows-Mayle, Erin E Paschel, Ajay Niranjan, John C Flickinger, L Dade Lunsford, and Peter C Gerszten.
• Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
• World Neurosurg. 2018 Dec 27.

BackgroundStereotactic radiosurgery (SRS) is an effective technique to create lesions of the trigeminal nerve to treat refractory trigeminal neuralgia. In the lumbar spine, the dorsal root ganglion (DRG) contains the body of the sensory neurons responsible for pain sensitivity. Neuromodulation of the DRG might therefore improve chronic peripheral pain. This study was performed to determine the feasibility, clinical, and histologic effects of delivering high-dose SRS targeted to the lumbar DRG in a rat model.MethodsFour Sprague Dawley male rats underwent 80 Gy maximum-dose single-fraction SRS to the left L5 and L6 DRG using the Leksell Gamma Knife Icon (Elekta, Atlanta, Georgia, USA). The right L5 and L6 DRGs served as controls. The animals were evaluated for motor and sensory deficits every 2 weeks and were sacrificed at 3 and 6 months after SRS. Common histologic techniques were used to assess for fibrosis and demyelination at the target levels.ResultsNo detectable motor or sensory deficits were seen in any animal. Histologic changes including fibrosis and loss of myelin were noted to the left L5 and L6 DRGs, but not the right side control DRGs. Fibrotic changes within the vertebral body were also evident on the treated sides of the vertebral bodies.ConclusionsWe were able to detect a demyelinating response from SRS delivered to the DRG in rats. Because such changes mimic those seen after trigeminal SRS in experimental animals, we hypothesize that radiosurgery may be a potential option in chronic spinal radicular pain amenable to neuromodulation.Copyright © 2018 Elsevier Inc. All rights reserved.

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