scholarly journals Ultrasound-guided fluoroscopic-verified trans-foraminal lumbar dorsal root ganglion pulsed radiofrequency modulation for radicular pain relief: clinical and cadaveric evaluation of the technique

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Shaaban Omar ◽  
Sherif El-Sayed Hegab ◽  
Mohamed Ihab Samy Reda ◽  
Sahar Ahmed El-Karadawy ◽  
Mowaffak Moustafa Saad ◽  
...  
Keyword(s):  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Radicular Pain ◽  
Lumbar Pain ◽  
Lumbar Region ◽  
Pulsed Radiofrequency ◽  
Ultrasound Guided ◽  
Sonographic Guidance ◽  
Spine Injections ◽  
Fluoroscopic Imaging

Abstract Background Ultrasound-guided lumbar pain interventions were thought to be difficult; the high acoustic impedance of bone hides the underling structures and needle path. Reviewing the sonoanatomy of the lumbar region using different planes and angles made better sonographic guidance for spine injections. The aim of this prospective study is to assess the accuracy and safety of ultrasound (US)-guided lumbar trans-foraminal pulsed radiofrequency of the dorsal root ganglion confirmed by fluoroscopic imaging in management of chronic radicular pain. Results Thirty-two patients, with 34 lumbar interventions, were included in the study. Thirty-one interventions out of 34 were performed successfully with overall accuracy of 91.18% and with minimal complications. The successful first trial placement of the cannula was calculated in 44.1% of interventions; multiple trials were needed in 47.1% while incorrect level was encountered in 8.8%. Visual analogue scale of pain and Oswestry Disability Index decreased significantly after intervention up to 3 months compared to the pre-intervention value. The analgesic consumption was reduced by mean of 73.44 ± 31.07% 1 month after intervention. Conclusions US-guided fluoroscopic-verified trans-foraminal PR of lumbar DRG is accurate, safe, and effective for CRP.

Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: A double blind sham controlled randomized clinical trial

Pain ◽  
2007 ◽  
Vol 127 (1) ◽  
pp. 173-182 ◽  
Author(s):  
Jan Van Zundert ◽  
Jacob Patijn ◽  
Alfons Kessels ◽  
Inge Lamé ◽  
Hans van Suijlekom ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Dorsal Root Ganglion ◽  
Randomized Clinical Trial ◽  
Dorsal Root ◽  
Radicular Pain ◽  
Pulsed Radiofrequency ◽  
Double Blind

scholarly journals The Effect of Bipolar Pulsed Radiofrequency Treatment on Chronic Lumbosacral Radicular Pain Refractory to Monopolar Pulsed Radiofrequency Treatment

2018 ◽  
Vol 1 (21;1) ◽  
pp. E97-E103 ◽  
Author(s):  
Min Cheol Chang
Keyword(s):  
Pain Relief ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Radicular Pain ◽  
Pulsed Radiofrequency ◽  
Lumbosacral Radiculopathy ◽  
Radiofrequency Treatment ◽  
Pulsed Radiofrequency Treatment ◽  
Number Of Patients ◽  
Stimulation Of

Background: Patients with lumbosacral radicular pain may complain of persisting pain after monopolar pulsed radiofrequency (PRF) treatment. Objective: We evaluated the effect of bipolar PRF stimulation of the dorsal root ganglion (DRG) in patients with chronic lumbosacral radicular pain who were unresponsive to both monopolar PRF stimulation of the DRG and transforaminal epidural steroid injection (TFESI). Study Design: This is a prospective observational study. Setting: The outpatient clinic of a single academic medical center in Korea. Methods: We retrospectively reviewed data from 102 patients who had received monopolar PRF to the DRG for management of lumbosacral radiculopathy. Of these, 32 patients had persistent radicular pain that was scored at least 5 on a numeric rating scale (NRS). Twenty-three of them were included in this study and underwent bipolar PRF of the DRG. The outcomes after the procedure were evaluated using the NRS for radicular pain before treatment and 1, 2, and 3 months after treatment. Successful pain relief was defined as ≥ 50% reduction in the NRS score compared with the score prior to treatment. Furthermore, at 3 months after treatment, patient satisfaction levels were examined. Patients reporting very good (score = 7) or good results (score = 6) were considered to be satisfied with the procedure. Results: The NRS scores changed significantly over time. At 1, 2, and 3 months after bipolar PRF, the NRS scores were significantly reduced compared with the scores before the treatment. Twelve (52.2%) of the 23 patients reported successful pain relief and were satisfied with treatment results 3 months after bipolar PRF. No serious adverse effects were recorded. Limitations: A small number of patients were recruited and we did not perform long-term follow-up. Conclusion: We believe the use of bipolar PRF of the DRG can be an effective and safe interventional technique for chronic refractory lumbosacral radiculopathy. It appears to be a potential option that can be tried before proceeding to spinal surgery. Key words: Bipolar, pulsed radiofrequency, lumbosacral radicular pain, chronic pain, dorsal root ganglion, spinal stenosis, herniated disc

scholarly journals Response to Pulsed and Continuous Radiofrequency Lesioning of the Dorsal Root Ganglion and Segmental Nerves in Patients with Chronic Lumbar Radicular Pain

2008 ◽  
Vol 2;11 (3;2) ◽  
pp. 137-144
Author(s):  
Thomas T. Simopoulos
Keyword(s):  
Side Effects ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Radicular Pain ◽  
Neurological Deficits ◽  
Pulsed Radiofrequency ◽  
Treatment Groups ◽  
Kaplan Meier ◽  
Segmental Nerve ◽  
Number Of Patients

Objectives: We aimed to prospectively evaluate the response and safety of pulsed and continuous radiofrequecy lesioning of the dorsal root ganglion/segmental nerves in patients with chronic lumbosacral radicular pain. Methods: Seventy-six patients with chronic lumbosacral radicular pain refractory to conventional therapy met the inclusion criteria and were randomly assigned to one of 2 types of treatment, pulsed radiofrequency lesioning of the dorsal root ganglion/segmental nerve or pulsed radiofrequency followed immediately by continuous radiofrequency. Patients were carefully evaluated for neurologic deficits and side effects. The response was evaluated at 2 months and was then tracked monthly. A Kaplan-Meier analysis was used to illustrate the probability of success over time and a Box-Whisker analysis was applied to determine the mean duration of a successful analgesic effect. Results: Two months after undergoing radiofrequency treatment, 70% of the patients treated with pulsed radiofrequency and 82% treated with pulsed and continuous radiofrequency had a successful reduction in pain intensity. The average duration of successful analgesic response was 3.18 months (± 2.81) in the group treated with pulsed radiofrequency and 4.39 months (±3.50) in those patients treated with pulsed and continuous radiofrequency lesioning. A Kaplan-Meier analysis illustrated that in both treatment groups the chance of success approached 50% in each group at 3 months. The vast majority of patients had lost any beneficial effects by 8 months. There was no statistical difference between the 2 treatment groups. No side effects or neurological deficits were found in either group. Conclusion: Pulsed mode radiofrequency of the dorsal root ganglion of segmental nerves appears to be a safe treatment for chronic lumbosacral radicular pain. A significant number of patients can derive at least a short-term benefit. The addition of heat via continuous radiofrequency does not offer a significant advantage. A randomized controlled trial is now required to determine the effectiveness of pulsed radiofrequency. Key words: Pulsed radiofrequency lesioning, dorsal root ganglion, segmental nerve, continuous radiofrequency lesioning, chronic lumbosacral radicular pain

scholarly journals Pulsed Radiofrequency Effects on the Lumbar Dorsal Root Ganglion of the Domestic Porcine: Pilot Study

2012 ◽  
Vol 12 (1) ◽  
pp. 51-58
Author(s):  
Mihails Arons ◽  
Mara Pilmane ◽  
Edgars Vasilevskis ◽  
Irina Evansa ◽  
Igors Panihins ◽  
...  
Keyword(s):  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Invasive Procedure ◽  
Minimal Invasive ◽  
Spinal Ganglia ◽  
Lumbar Region ◽  
Pulsed Radiofrequency ◽  
Hsp 70 ◽  
Control Side ◽  
Inhibitory Role

SummaryIntroduction.Pulsed radiofrequency (PRF) is a percutaneous minimal invasive procedure for chronic pain management that can be used when conservative treatment methods have been ineffective. The effectiveness of PRF was demonstrated in various good quality randomized control studies, but mechanisms of action are still unclear.Aim of the Study.The aim of our study is to analyse the histological effects of PRF on the domestic porcine dorsal root ganglion (DRG), and evaluate the expression of biomarkers in gangliocytes of the subject(s).Materials and Methods.A total 3 domestic porcines were investigated. Under general anaesthesia and X-ray control, DRG PRF was performed. Four lumbar DRGs (L1, L2, L3, L4) were randomly treated. The opposite side DRGs was used as control. One month after the procedure the animal was euthanized. The lumbar region of the spine was placed in 10% formaldehyde for a month. After this fixation DRG samples were prepared for slide analysis. They were embedded in paraffin in order to obtain 3mm thick sections, which were then cut by microtome and collected on slide glasses. Using standard immunohistochemical reactions, the materials were tinted to define biomarkers neurofilaments (NF), glial fibrillary acidic protein (GFAP), heat shock protein - 70 (Hsp-70) expression and apoptosis by transferase-mediated dUTP nick-end labeling (TUNEL) analysis.Results.The number of cells with NF (26,0 ± 3,0 vs 16,1 ± 3,3; p<0,05), GFAP (12,0 ± 1,3 vs 3,2 ± 0,9; p<0,05) and Hsp-70 (10,0 ± 1,6 vs 4,2 ± 1,0; p<0,05) expression, were larger in the PRF side comparing with the control side. Additionally, glial cells in spinal ganglia of both sides demonstrated immunoreactivity. The instances of apoptosis were not significantly different, in statistical terms, between the control and experimental sides (18,0 ± 4,0 vs 20,0 ± 4,0; p=0,35).Conclusions.PRF in spinal gangliocytes of lumbar region increases neural tissue cytoskeleton factors like NF and GFAP suggesting about active regeneration processes into the cells 1 month after the procedure. Spinal gangliocytes one month after PRF treatment notably increases Hsp-70 expression suggesting about activation of cellular activity and inhibitory role reducing of oxidative stress. Similar number of apoptotic cells in spinal ganglia of lumbar region after PRF and control side suggests about inhibitory role of PRF on programmed cell death and stimulation of cell survival.

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