Percutaneous Pulsed Radiofrequency in the Treatment

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• Percutaneous Pulsed Radiofrequency in the
  Treatment
• of Cervical and Lumbar Radicular Pain
• Experiences of 154 Patients
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Introduction of Pulsed RF

• Precise anatomic locations
• Brief pulses of high-voltage, radiofrequency
  range electrical current
• Not to produce a heat lesion above 45C
• Produce analgesia without producing destruction
  of nerves
• Pain relief caused by cellular changes induced by
  magnetic fields, not tissue destruction by heat
• Neuromodulation, not neuroablation
• Success in reducing a number of different chronic
  pain states in past ten years

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Reports on Midline

• Munglani R. The longer term effect of pulsed
  radiofrequency for neuropathic pain. Pain
  1999804379.
• Van Zundert J, Brabant S, Van de Kelft E,
  Vercruyssen A, Van Buyten JP. Pulsed
  radiofrequency treatment of the Gasserian
  ganglion in patients with idiopathic trigeminal
  neuralgia. Pain 2003104(3) 44952.
• Van Zundert J. , Percutaneous Pulsed
  Radiofrequency Treatment of the Cervical Dorsal
  Root Ganglion in the Treatment of Chronic
  Cervical Pain Syndromes A Clinical Audit,
  Neuromodulation, Volume 6, Number 1, 2003 614
• Geurts JW, van Wijk RM, Wynne HJ, Hammink E,
  Buskens E, Lousberg R, et al. Radiofrequency
  lesioning of dorsal root ganglia for chronic
  lumbosacral radicular pain a randomised,
  doubleblind, controlled trial. Lancet
  2003361(9351)216.
• Mikeladze G, Espinal R, Finnegan R, Routon J,
  Martin D Pulsed radiofrequency application in
  treatment of chronic zygapophyseal joint pain.
  Spine J 2003 33602
• Cohen SP, Foster A. Pulsed radiofrequency as a
  treatment for groin pain and orchialgia. Urology
  20036145.
• Sluijter ME. The role of radiofrequency in failed
  back surgery patients. Curr Rev Pain
  200044953.
• Shah RV, Racz GB. Long-term relief of
  posttraumatic headache by sphenopalatine ganglion
  pulsed radiofrequency lesioning a case report.
  Arch Phys Med Rehabil 200485(6)10136.
• Teixeira A, Grandinson M, Sluijter ME. Pulsed
  Radiofrequency for Radicular Pain Due to a
  Herniated Intervertebral DiscAn Initial Report,
  Pain Practice, Volume 5, Issue 2, 2005 111115

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Reports on Midline

• This is a retrospective analysis on 114 Patients
  with a chief complaint of axial cervical or
  lumbar pain and who denied radicular symptoms
  were treated with PRF. In 68 (68/114, 59.6)
  patients, the procedure was successful (pain
  reduction more than 50) and lasted on average
  3.93 1.86 months.
• Mikeladze G, Espinal R, Pulsed radiofrequency
  application in treatment
• of chronic zygapophyseal joint pain. Spine J
  2003 33602
• This paper reports the results of a clinical
  audit of the first consecutive 18 patients with
  intractable cervicobrachialgia and who were
  treated with PRF of the cervical dorsal root
  ganglion. Satisfactory pain relief of at least
  50 was achieved in 13 of 18 (72) patients at
  post-operation 8 weeks. More than one year after
  treatment, 6 patients (33) continue to rate
  treatment outcome as good or very good.
• Van Zundert J. , Percutaneous Pulsed
  Radiofrequency Treatment of the Cervical
• Dorsal Root Ganglion in the Treatment of Chronic
  Cervical Pain Syndromes
• A Clinical Audit, Neuromodulation, Volume 6,
  Number 1, 2003 614

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Reports on Midline

• This is a retrospective study on 13 consecutive
  patients with radicular pain, due to a herniated
  intervertebral disc, at levels L3 to S1.All were
  treated with PRF of lumbar dorsal root ganglion.
  The numeric rating scale (NRS) score fell from
  7.83 to 2.25 over the first 2 weeks.
• Teixeira A , Pulsed Radiofrequency for Radicular
  Pain Due to a Herniated Intervertebral
• Disc An Initial Report, Pain Practice, Volume
  5, Issue 2, 2005 111115
• This study reports the result of pulsed RF in 28
  patients suffering from severe radicular pain
  treated by pulsed RF .There were 20 cases of low
  back pain and 8 with neck pain. The first
  follow-up after 3 months revealed the following
  results excellent results in 2 cases (7.1),
  good results in 12 cases (42.9), fair in 9
  (32.1) and unresponsiveness to treatment in 5
  (17.9). Significant reduction was found in the
  Visual Analog Scale for pain from an average of
  8.8 to 4.2 after 3 months, 4.8 after 6 months and
  4.9 after 1 year.
• Pevzner E David R Leitner Y, Pulsed
  radiofrequency treatment of severe
• radicular pain, Harefuah, 2005 Mar Vol. 144 (3),
  pp. 178-80, 231.

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Patient selection

• We collected 154 cases with a chief complaint of
  cervical or lumbar radicular pain due to a
  herniated intervertebral disc or previous failed
  surgery, from September 2004 to October 2005
• Follow-up period was from one week to one year
  postoperatively.
• There are 71 male and 83 female patients.
• The mean preoperative visual analog pain scale of
  patients who had cervical, lumbar radicular pain
  were 67.5514.37, 65.5216.44 (0-100).

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Table 1. The demographic and clinical features of
154 patients
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Table 2. The treatment levels and disease
classification
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Table 3. Results after cervical pulsed
radiofrequency stimulation
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Figure 1.
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Figure 2. Visual analog pain scale distribution
on cervical patients with improvement ? 50 and
last for more than 1 month
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Table 4. Results after lumbar pulsed
radiofrequency stimulation
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Figure 3.
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Figure 4. Visual analog pain scale distribution
on lumbar patients with improvement ? 50 and
last for more than 1 month
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Results

• 30 in 49 numbers (61.22) and 56 in 116 numbers
  (48.28) after cervical, and lumbar pulse
  radiofrequency stimulation had the initial
  improvement 50 in the first month follow up.
• 22 in 40 numbers (55.00) and 43 in 108 numbers
  (39.81) after cervical and lumbar pulse
  radiofrequency stimulation had pain relief 50
  at the follow-up period of six months.
• After one year follow up, 4 in 7 numbers (57.14)
  and 10 in 43 numbers (23.26) after cervical and
  lumbar pulse radiofrequency stimulation had the
  pain relief effect 50.

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Conclusion

• The results of this retrospective analysis showed
  that the application of pulsed radiofrequency is
  a safe and useful intervention for cervical and
  lumbar radicular pain (approximately one year).
• Although pulsed radiofrequency appears to provide
  intermediate-term relief of pain, further studies
  with long-term follow-up are necessary.

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Thank you for your attention