title: Effect of bipolar pulsed radiofrequency on refractory chronic cervical radicular pain: A report of two cases.
abstract: BACKGROUND
  Despite undergoing transforaminal epidural steroid injection (TFESI), many patients complain of persisting cervical radicular pain. For the management of chronic cervical radicular pain, clinicians are widely applying pulsed radiofrequency (PRF) stimulation to dorsal root ganglions (DRGs). To enhance the effect of PRF stimulation, we conducted bipolar PRF stimulation in 2 patients with chronic cervical radicular pain that was refractory to monopolar PRF and repeated TFESIs.
  
  
  METHODS
  Patients 1 and 2 presented with a numeric rating scale (NRS) score of 7 and 6 for chronic cervical radicular pain, respectively, despite undergoing monopolar PRF and 2 TFESIs.
  
  
  METHODS
  On cervical magnetic resonance imaging, foraminal stenosis at the right C6-7 and right central to right foraminal disc protrusion on C6-7 were observed in patients 1 and 2, respectively. Two patients showed a positive response on diagnostic right C7 selective nerve root block with 0.5 mL of 1% lidocaine.
  
  
  METHODS
  Bipolar PRF stimulation was performed under C-arm fluoroscopy. Two parallel RF cannulas (less than 1 cm apart) were used for DRG stimulation. The PRF treatment was administered at 5 Hz and a 5-ms pulsed width for 360 seconds at 45 V with the constraint that the electrode tip temperature did not exceed 42°C.
  
  
  RESULTS
  At the 2-week and 1-month follow-up, after undergoing bipolar PRF, the pain of patient 1 was completely relieved, and at 2, 3, and 6 months, the pain was scored as NRS 2. In patient 2, at the 2-week follow-up after undergoing bipolar PRF, pain severity was reduced from NRS 6 to 2. The effect of bipolar PRF on patient 2 lasted for at least 6 months. No adverse effects were observed in either patient.
  
  
  CONCLUSIONS
  Application of bipolar PRF to DRGs seems to be an effective and safe technique for treating refractory chronic cervical radicular pain.
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
authors.forename: Min Cheol
authors.initials: MC
authors.lastname: Chang
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D019547:Neck Pain / Q000628:therapy*; D010147:Pain Measurement; D010148:Intractable Pain / Q000628:therapy*; D061208:Pulsed Radiofrequency Treatment / Q000379:methods*; D011843:Radiculopathy / Q000628:therapy*; D016896:Treatment Outcome