Chronic intractable lumbosacral radicular pain, is there a remedy? Pulsed radiofrequency treatment and volumetric modifications of the lumbar dorsal root ganglia

Abstract

Purpose

Evaluation of clinical and radiological effects of the therapeutic outcome of CT-guided pulsed radiofrequency (PRF) treatment adjacent to the lumbar dorsal root ganglion (DRG) for patients with chronic intractable lumbosacral radicular pain in a single-center prospective longitudinal study in order to evaluate predictive factors of safety and therapeutic success.

Materials and methods

Thirty patients, from 2016 to 2018, were enrolled (age: 42–80 aa, 66.7% men and 33.3% females) with low back pain, lumbosciatalgia and/or lumbocruralgia, resistant to previous medical and physical treatments for a period not < 3 months, failure of surgical and chemiodiscolysis with ozone oxygen therapy. Each patient was subjected to a clinical evaluation (antalgic walking, sensitive deficit, interviews with specific questionnaires: ODI, RDQ,VAS) and to a radiological evaluation with MRI examination, before and 30 days after the CT-guided PRF treatment. Measurements of the thickness of the involved and not involved DRG were taken using common postprocessing software of MRI examinations in order to have measurement parameters for comparison. We analyzed the clinical course using the paired samples T test in order to evaluate modification for each clinical and radiological parameter (statistical significance p < 0.05).

Results

Significant improvements of the clinical outcomes with a good resolution of the pain symptoms (VAS evaluation: The score fell from 68.47 to 39.17 with a difference of 29.3 and a reduction of the 42.79% in the perceived pain, p = 0.00000152). The thickness of DRG falls from an average media of 0.586–0.448 cm (p = 0.000085), with a difference of 0.138 cm and a percentage reduction of 22.30%.

Conclusions

PRF treatment of the DRG may be considered for patients with chronic severe lumbosacral radicular pain refractory to conventional medical management when other noninvasive or surgical procedures fail. It is minimally invasive, inexpensive and simple to perform with no complications.

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Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Alberto Negro, Fabio Tortora and Camilla Russo. The first draft of the manuscript was written by Alberto Negro, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alberto Negro.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study did not need to be approved by the ethics commission. The pulsed radiofrequency treatment used and described in our study represents already a possible therapy for neuropathic pain that can be delivered in a specific day surgery at our department, in accordance with the law and the national ethical guidelines of our country. All the treatments described in the study were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave their informed consent prior to their inclusion in the study. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Tortora, F., Negro, A., Russo, C. et al. Chronic intractable lumbosacral radicular pain, is there a remedy? Pulsed radiofrequency treatment and volumetric modifications of the lumbar dorsal root ganglia. Radiol med 126, 124–132 (2021). https://doi.org/10.1007/s11547-020-01212-z

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Keywords

  • Chronic radicular pain
  • Pulsed radiofrequency treatment effects
  • Dorsal root ganglion volumetric modifications
  • Pain relief