Pulsed radiofrequency ablation of dorsal root ganglions in the treatment of postsurgical radicular pain

Volkov I.V., Karabaev I.S., Ptashnikov D.A., Konovalov N.A., Poyarkov K.A.

Abstract


Introduction
The incidence of radicular pain that arises without a surgically significant cause of compression is 4.8–10.2 % in the structure of the "failed back surgery syndrome". Pulsed radiofrequency treatment (PRF) is successfully used for several neuropathic pain syndromes, but its effectiveness for postoperative radicular pain has not been studied sufficiently.
Materials and methods
Prospective non-randomized open study was performed. A group of 56 patients with postoperative radicular pain syndrome was included. Twenty-two patients of the index group underwent PRF treatment of dorsal root ganglia (DRG) in combination with transforaminal epidural steroid injection (TFES) while 34 patients of the control group received only TFES. Outcome of a successful response was defined as a 50 % reduction in numeric rating scale (NRS-11) or 4-points pain reduction and/or a 20 % decrease in the Oswestry Disability Index (ODI), and/or an 8-point decrease in the sciatica bothersomeness index (SBI) from the baseline and the effect duration for six or more months. Dynamics of the decrease in the parameters studied was assessed and compared; a search for significant prognostic factors was carried out.
Results
Positive results of interventions, based on specified criteria, were obtained in 18 patients (81.82 %) in the index group and in 19 patients (55.88 %) in the control group (significant difference, p = 0.045). There was a significant decrease in all indices after the intervention, a decrease in SBI in the main group was significantly lower than in the control one, p = 0.021. There were no major complications and side effects. The presence of allodynia/hyperpathy was the main negative prognostic factor in the index and in control groups with OR 0.79 at 95 % CI (0.735–0.897) and OR 0.82 at 95 % CI (0.780–0.929), respectively.
Conclusion
The use of the PRF in combination with TFES is an effective method in comparison with TFES alone for treatment of postsurgical radicular pain syndrome.

Keywords


degenerative disc disease, radicular pain, pulsed radiofrequency treatment, epidural steroid injection, failed back surgery syndrome

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