Pulsed Radiofrequency Dorsal Root Ganglion-Fluoroscopy Guide for Lumbar Radicular Pain
Abstract
Background: Lumbosacral radicular pain is the most common neuropathic pain. Pulsed Radio Frequency (PRF) is a method that believes to be safe and effective for reducing pain.
Case: A 43-year-old woman experiences chronic right lumbar radiculopathy due to Herniated nucleus pulposus (HNP) L4-5. Anamnesis and physical examination show a sign of neuropathic pain. The MRI examination shows a paracentral disc protrusion L4-5 that compresses the transversing nerve L5. The conservative management did not produce a satisfying result indicated by the patient still experience pain with the Numeric Rating Scale (NRS) 4-5. Patient unable to do activity properly. We perform pain management using the dorsal root ganglion L5 pulsed radiofrequency-fluoroscopy (PRF) and producing a positive outcome. Patients experience a decrease in pain intensity with NRS 1. The examination on one and two months post-intervention show an improvement. Patient able to do the daily activity with NRS 1-2.
Conclusion: Pulsed radiofrequency dorsal root ganglion-fluoroscopy guide that relatively safe, minimum complications, and minimal side effects, making it the preferred treatment for chronic lumbar radicular pain.
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Deyo RA, Mirza SK. Herniated Lumbar Intervertebral Disk. N Engl J Med. 2016;374(18):1763-1772. doi:10.1056/nejmcp1512658
Faccini G, Spinnato P, Guglielmi G, Albisibbi U, Bazzocchi A. A comprehensive review of pulsed radiofrequency in the treatment of pain associated with a different spinal condition. Br J Radiol. 2017;90:20150406.
Frymoyer J, Cats-Baril W. An overview of the incidences and costs of low back pain. Orthop Clin North Am. 1991;22(2):263-271.
Cho HK, Cho YW, Kim EH, Sluijter ME, Hwang SJ, Ahn SH. Changes in pain behavior and glial activation in the spinal dorsal horn after pulsed radiofrequency current administration to the dorsal root ganglion in a rat model of lumbar disc herniation: Laboratory investigation. J Neurosurg Spine. 2013;19(2):256-263. doi:10.3171/2013.5.SPINE12731
Manchikanti L, Cash KA, Pampati V, Falco FJE. Transforaminal epidural injections in chronic lumbar disc herniation: A randomized, double-blind, active-control trial. Pain Physician. 2014;17(4):489-502.
Trinidad JM, Carnota AI, Failde I, Torres LM. Radiofrequency for the treatment of lumbar radicular pain: Impact on surgical indications. Pain Res Treat. 2015;2015. doi:10.1155/2015/392856
Khalifa OA, Saadalla AT. Steroids versus pulsed radiofrequency in treatment of radicular pain due to lumbar disc prolapse: a randomized clinical trial. Res Opin Anesth Intensive Care. 2017;4(4):184. doi:10.4103/roaic.roaic_54_16
Koh W, Choi SS, Karm MH, et al. Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: A randomized controlled study. Pain Med (United States). 2015;16(3):432-441. doi:10.1111/pme.12624
Pope JE, Deer TR, Kramer J. A Systematic Review: Current and Future Directions of Dorsal Root Ganglion Therapeutics to Treat Chronic Pain. Pain Med (United States). 2013;14(10):1477-1496. doi:10.1111/pme.12171
De Schepper EIT, Overdevest GM, Suri P, et al. Diagnosis of lumbar spinal stenosis: An updated systematic review of the accuracy of diagnostic tests. Spine (Phila Pa 1976). 2013;38(8). doi:10.1097/BRS.0b013e31828935ac
Van Boxem K, Cheng J, Patijn J, et al. 11. Lumbosacral radicular pain. Pain Pract. 2010;10(4):339-358. doi:10.1111/j.1533-2500.2010.00370.x
Zuidema X, Breel J, Wille F. Paresthesia mapping: A practical workup for successful implantation of the dorsal root ganglion stimulator in refractory groin pain. Neuromodulation. 2014;17(7):665-669. doi:10.1111/ner.12113
Luchtmann M, Firsching R. Lumbar disc herniation: Evidence-based guidelines–a review. Indian Pract. 2016;69(3):61-66. http://articles.theindianpractitioner.com/index.php/tip/article/view/478
Wani SK, Deshpande N, Student PG. Correlation of Pain and Disability With Mri Findings in Patients With Lumbar Discogenic Back Pain. Int J Physiother Res. 2014;2(2):418-441. www.ijmhr.org/ijpr.html
Van Boxem K, Huntoon M, Van Zundert J, Patijn J, Van Kleef M, Joosten EA. Pulsed radiofrequency: A review of the basic science as applied to the pathophysiology of radicular pain: A call for clinical translation. Reg Anesth Pain Med. 2014;39(2):149-159. doi:10.1097/AAP.0000000000000063
Lee D, YW C, Ahn S, MC. C. The Effect of Bipolar Pulsed Radiofrequency Treatment on Chronic Lumbosacral Radicular Pain Refractory to Monopolar Pulsed Radiofrequency Treatment. Pain Physician. 21(2):E97-E103.
Shanthanna H, Chan P, McChesney J, Thabane L, Paul J. Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: A randomized, placebo-controlled pilot study. J Pain Res. 2014;7:47-55. doi:10.2147/JPR.S55749
Van Boxem K, N de M, Kessels A, Van Kleef M, Van Zundert J. Pulsed radiofrequency for chronic intractable lumbosacral radicular pain: a six-month cohort study. Pain Med. 2015;16(6):1155-1162. doi:doi: 10.1111/pme.12670
Arai YCP, Nishihara M, Yamamoto Y, et al. Dorsal Root Ganglion Pulsed Radiofrequency for the Management of Intractable Vertebral Metastatic Pain: A Case Series. Pain Med (United States). 2015;16(5):1007-1012. doi:10.1111/pme.12629
Vigneri S, Sindaco G, Gallo G, et al. Effectiveness of pulsed radiofrequency with multifunctional epidural electrode in chronic lumbosacral radicular pain with neuropathic features. Pain Physician. 2014;17(6):477-486.
Podhajsky RJ, Sekiguchi Y, Kikuchi S, Myers RR. The histologic effects of pulsed and continuous radiofrequency lesions at 42°C to rat dorsal root ganglion and sciatic nerve. Spine (Phila Pa 1976). 2005;30(9):1008-1013. doi:10.1097/01.brs.0000161005.31398.58
Park JW, Nam HS, Cho SK, Jung HJ, Lee BJ, Park Y. Kambin’s Triangle Approach of Lumbar Transforaminal Epidural Injection with Spinal Stenosis. Ann Rehabil Med. 2011;35(6):833. doi:10.5535/arm.2011.35.6.833
Malik KM, M. Nelson A, J. Avram M, Lee Robak S, T. Benzon H. Efficacy of Pregabalin in the Treatment of Radicular Pain: Results of a Controlled Trial. Anesthesiol Pain Med. 2015;5(4). doi:10.5812/aapm.28110
Lo Y, Cheong P, George JM, et al. Pregabalin and Radicular Pain Study (PARPS) for Cervical Spondylosis in a Multiracial Asian Population. J Clin Med Res. 2013;6(1):66-71. doi:10.4021/jocmr879w
DOI: http://dx.doi.org/10.21776/ub.jap.2021.002.02.02
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