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 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 Effectiveness of Pulsed Radiofrequency with Multifunctional Epidural Electrode in Chronic Lumbosacral Radicular Pain with Neuropathic Features

2014 ◽  
Vol 6;17 (6;12) ◽  
pp. 477-486 ◽  
Author(s):  
Simone Vigneri
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Rating Scale ◽  
Radicular Pain ◽  
Pain Intensity Score ◽  
Pulsed Radiofrequency ◽  
Number Of Patients ◽  
Pre Treatment

Background: Lumbosacral radicular pain is a common clinical finding with a statistical prevalence ranging from 9.9% to 25% in the general population. Objective: To investigate the effectiveness of dorsal root ganglion pulsed radiofrequency (PRF) in patients with chronic lumbosacral radicular pain and neuropathic features. Study Design: Prospective case series clinical outcome study. Methods: We evaluated 34 patients with lumbosacral neuropathic pain who underwent PRF at the corresponding level of radicular symptoms distribution (ranging from L3 to S1). Each patient suffered a single leg-radiating pain with probable neuropathic features (assessed with clinical grading) lasting for > 6 months and unresponsive to previous treatments. A multifunctional PASHA-electrode® was introduced with trans-sacral access through a hollow needle, placed under fluoroscopic guidance into the lumbosacral epidural space and its active tip moved close to the dorsal root ganglion responsible of the clinical symptoms. After connecting the electrode to a generator, stimulation tests were performed and PRF was started and applied for 240 seconds at a frequency of 2Hz, amplitude of 45 V and a tip temperature between 40 – 42°C. If the pain involved more than a single nerve root, the electrode was placed at a different segment and the procedure repeated. Outcome measures included the pain intensity score on a 0 – 10 numeric rating scale (NRS) and the Italian Pain Questionnaire (QUID) at pre-treatment, one and 6 months post-treatment. P values < 0.05 were considered statistically significant. Results: In comparison with pre-treatment, a significant reduction in pain score was observed in mean NRS either at one and 6 months (P < 0.001). The QUID - Pain Rating Index rank displayed a parallel trend at the first (P < 0.001) and last follow-up (P = 0.01). Moreover, a direct correlation between the 2 scales occurred, showing a parallel score decreasing (P < 0.001). Eighteen (52.9%) and 17 (50%) of 34 patients showed pain reduction in NRS > 2 points and > 30%, at one and 6 months, respectively. Limitations: The non-controlled design of the study, the patients were heterogeneous, the small number of patients, and the duration of follow-up was limited to 6 months. Conclusions: PRF of dorsal root ganglion performed with a multifunctional electrode for > 240 seconds appears to be safe and might be more effective than the classic 120 seconds needlemediated approach. Therefore, it may be considered as a valuable tool for the treatment of lumbosacral radicular pain with neuropathic features. Key words: PRF, radicular pain, neuropathic pain, DRG, NRS, PRIr-T, multifunctional electrode

scholarly journals Retrospective Review of the Efficacy and Safety of Repeated Pulsed and Continuous Radiofrequency Lesioning of the Dorsal Root Ganglion/Segmental Nerve for Lumbar Radicular Pain

2011 ◽  
Vol 3;14 (3;5) ◽  
pp. 371-376
Author(s):  
Jyotsna V. Nagda
Keyword(s):  
Pain Relief ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Chart Review ◽  
Average Duration ◽  
Retrospective Chart Review ◽  
Radicular Pain ◽  
Pulsed Radiofrequency ◽  
Segmental Nerve ◽  
The Mean

Background: Chronic lumbosacral radicular pain is a common source of radiating leg pain seen in pain management patients. These patients are frequently managed conservatively with multiple modalities including medications, physical therapy, and epidural steroid injections. Radiofrequency has been used to treat chronic radicular pain for over 30 years; however, there is a paucity of literature about the safety and efficacy of repeat radiofrequency lesioning. Objectives: To determine the safety, success rate, and duration of pain relief of repeat pulsed radiofrequency (PRF) and continuous radiofrequency (CRF) lesioning of the dorsal root ganglion (DRG)/ sacral segmental nerves (SN) in patients with chronic lumbosacral radicular pain. Study Design: Retrospective chart review Setting: Outpatient multidisciplinary pain center Methods: Medical record review of patients who were treated with pulsed and continuous radiofrequency lesioning of the lumbar dorsal root ganglia and segmental nerves and who reported initial success were evaluated for recurrence of pain and repeat radiofrequency treatment. Responses to subsequent treatments were compared to initial treatments for success rates, average duration of relief, and adverse neurologic side-effects. Limitations: Retrospective chart review without a control group. Results: Twenty-six women and 24 men were identified who received 50% pain relief or better after PRF and CRF of the lumbar DRG/ sacral SN for lumbosacral radicular pain. The mean age was 62 years (range, 25-86). The mean duration of relief for the 40 patients who had 2 treatments was 4.7 months (range 0-24; Se [standard error] 0.74). Twenty-eight patients had 3 treatments with an average duration of relief of 4.5 months (range 0-19 months; Se 0.74). Twenty patients had 4 treatments with a mean duration of relief of 4.4 months (range 0.5-18; Se 0.95) and 18 patients who had 5 or more treatments received an average duration of relief of 4.3 months (range 0.5-18; Se 1.03). The average duration of relief and success frequency remained constant after each subsequent radiofrequency treatment. Of the 50 total patients, there was only 1 reported complication, specifically, transient thigh numbness which resolved after one week. Conclusions: Repeated pulsed and continuous radiofrequency ablation of the lumbar dorsal root ganglion/segmental nerve shows promise to be a safe and effective long-term palliative management for lumbosacral radicular pain in some patients. Key words: Pulsed radiofrequency lesioning, dorsal root ganglion, segmental nerve, continuous radiofrquency elsioning, chronic lumbosacral radicular pain

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 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.

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