Response to pulsed and continuous radiofrequency lesioning of the dorsal root ganglion and segmental nerves in patients with chronic lumbar radicular pain.
OBJECTIVE
We aimed to prospectively evaluate the response and safety of pulsed and continuous radiofrequecy lesioning of the dorsal root ganglion/segmental nerves in patients with chronic lumbosacral radicular pain.


METHODS
Seventy-six patients with chronic lumbosacral radicular pain refractory to conventional therapy met the inclusion criteria and were randomly assigned to one of 2 types of treatment, pulsed radiofrequency lesioning of the dorsal root ganglion/segmental nerve or pulsed radiofrequency followed immediately by continuous radiofrequency. Patients were carefully evaluated for neurologic deficits and side effects. The response was evaluated at 2 months and was then tracked monthly. A Kaplan-Meier analysis was used to illustrate the probability of success over time and a Box-Whisker analysis was applied to determine the mean duration of a successful analgesic effect.


RESULTS
Two months after undergoing radiofrequency treatment, 70% of the patients treated with pulsed radiofrequency and 82% treated with pulsed and continuous radiofrequency had a successful reduction in pain intensity. The average duration of successful analgesic response was 3.18 months (+/- 2.81) in the group treated with pulsed radiofrequency and 4.39 months (+/-3.50) in those patients treated with pulsed and continuous radiofrequency lesioning. A Kaplan-Meier analysis illustrated that in both treatment groups the chance of success approached 50% in each group at 3 months. The vast majority of patients had lost any beneficial effects by 8 months. There was no statistical difference between the 2 treatment groups. No side effects or neurological deficits were found in either group.


CONCLUSIONS
Pulsed mode radiofrequency of the dorsal root ganglion of segmental nerves appears to be a safe treatment for chronic lumbosacral radicular pain. A significant number of patients can derive at least a short-term benefit. The addition of heat via continuous radiofrequency does not offer a significant advantage. A randomized controlled trial is now required to determine the effectiveness of pulsed radiofrequency.
Simopoulos
Thomas T
TT
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. tsimopou@bidmc.harvard.edu
Kraemer
Jan
J
Nagda
Jyotsna V
JV
Aner
Musa
M
Bajwa
Zahid H
ZH
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004311:Double-Blind Method; D005069:Evaluation Studies as Topic; D005260:Female; D005727:Ganglia, Spinal / Q000528:radiation effects*; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D010865:Pilot Projects; D011446:Prospective Studies; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000209:etiology*; D011846:Radio Waves / Q000009:adverse effects*; D011859:Radiography / Q000379:methods; D016896:Treatment Outcome