The role of the dorsal root ganglion in cervical radicular pain: diagnosis, pathophysiology, and rationale for treatment.
Cervical radicular pain affects 83 per 100,000 adults annually. Diagnosis by means of physical examination, imaging, and electrophysiological studies is characterized by high specificity but low sensitivity. In this review, we focus on the role of the dorsal root ganglion and those treatment modalities that aim at pathophysiological mechanisms occurring after injury to the dorsal root ganglion. Cervical nerve injury initiates multiple events that lead to changes in nerve function and result in spontaneous firing at the dorsal root ganglion. Among these, inflammation and changes in ion-channel function play a pivotal role. Although many treatment modalities are described in the literature, the available evidence for efficacy does not allow us to formulate definitive conclusions on the optimal therapy. A lack of evidence is reported for cervical spine surgery. Interlaminar epidural steroid administration and radiofrequency techniques adjacent to the cervical dorsal root ganglion have the highest, but still weak recommendations.
Department of Anesthesiology and Pain Management, University Hospital Maastricht, Maastricht, The Netherlands. janvanzundert@pandora.be
Jan
J
Van Zundert
Donal
D
Harney
Elbert A J
EA
Joosten
Marcel E
ME
Durieux
Jacob
J
Patijn
Martin H
MH
Prins
Maarten
M
Van Kleef
D000818:Animals; D019468:Disease Management; D005727:Ganglia, Spinal / Q000502:physiology*; D006801:Humans; D010146:Pain / Q000175:diagnosis / Q000503:physiopathology; D059408:Pain Management; D011843:Radiculopathy / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*