Percutaneous Pulsed Radiofrequency in the Treatment

of Cervical and Lumbar Radicular Pain

Experiences of 154 Patients

經皮脈衝高頻療法治療頸腰椎神經根疼痛—一百五十四個病人的經驗

趙紹清醫師 ,鄒錫凱醫師 ,沈炯祺主任

台中榮民總醫院神經外科

Introduction of Pulsed RF Precise anatomic locations Brief “pulses” of high-voltage, radiofrequency

range electrical current Not to produce a heat lesion above 45°C 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

Reports on Midline Munglani R. The longer term effect of pulsed radiofrequency for neuropathic pain. Pain 1999;80:437–9. Van Zundert J, Brabant S, Van de Kelft E, Vercruyssen A, Van Buyten JP. Pulsed radiofrequency treatme

nt of the Gasserian ganglion in patients with idiopathic trigeminal neuralgia. Pain 2003;104(3): 449–52. 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 6–14

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 2003;361(9351):21–6.

Mikeladze G, Espinal R, Finnegan R, Routon J, Martin D: Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain. Spine J 2003; 3:360–2

Cohen SP, Foster A. Pulsed radiofrequency as a treatment for groin pain and orchialgia. Urology 2003;61:45.

Sluijter ME. The role of radiofrequency in failed back surgery patients. Curr Rev Pain 2000;4:49–53. Shah RV, Racz GB. Long-term relief of posttraumatic headache by sphenopalatine ganglion pulsed radi

ofrequency lesioning: a case report. Arch Phys Med Rehabil 2004;85(6):1013–6. Teixeira A, Grandinson M, Sluijter ME. Pulsed Radiofrequency for Radicular Pain Due to a Herniated I

ntervertebral Disc—An Initial Report, Pain Practice, Volume 5, Issue 2, 2005 111–115

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; 3:360–2

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 6–14

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 111–115

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.

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 67.55±14.37, 65.52±16.44 (0-100).

Table 1. The demographic and clinical features of 154 patients

 

Cervical(N=49)

Lumbar (N=116)

Total(N=165)

Male [range] 17 [32-76] 58 [26-92] 75

Female [range] 32 [39-79] 58 [31-88] 90

Age (years, mean ± SD)

53.20 ± 10.99 62.42 ± 13.16 

Visual analog pain scale (0-100, mean ± SD)

67.55 ± 14.37 65.52 ± 16.44 

  Cervical (n=49) Lumbar (n=116)Nerve roots (C3) 3 (L3) 18

  (C4) 40 (L4) 95  (C5) 49 (L5) 112  (C6) 30 (S1) 19  (C7) 2  

Disease classification    

Cervical HIVD with radiculopathy 44  

Previous failed cervical surgery 5  

Lumbar HIVD with radiculopathy   88

Failed back surgery syndrome   28

Treatment side    

R’t. 29 66

L’t. 20 50

Table 2. The treatment levels and disease classification

*The improvement was defined as patient who has the pain relief> 0; The satisfaction was defined as patient who has the pain relief 50%≧

 

  1 week(N=49)

1 month(N=49)

3 months(N=49)

6 months(N=40)

9 months(N=21)

1 year(N=7)

worse 0 0 0 0 0 0

0% 10 10 14 15 7 3

0<&<50% 13 9 8 3 2 0

50<=&<100 24 22 19 13 8 3

100% 2 8 8 9 4 1

Improvement rate (%)* 79.59 79.59 71.43 62.50 66.67 57.14

Satisfactory rate (%)* 53.06 61.22 55.10 55.00 57.14 57.14

Table 3. Results after cervical pulsed radiofrequency stimulation

0%

20%

40%

60%

80%

100%

1 week(N=49)

1 month(N=49)

3 months(N=49)

6 months(N=40)

9 months(N=21)

1 year(N=7)

After Cervical Pulsed Radiofrequency

Symptom FreeBetterSlightly BetterUnchangedAggravated

Figure 1.

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

Before RF 1 week 1 month 3 months 6 months 9 months 1 year

After Cervical Pulsed Radiofrequency

Pain Scale

Figure 2. Visual analog pain scale distribution on cervical patients with improvement ≧ 50% and last for more than 1 month

*The improvement was defined as patient who has the pain relief> 0; The satisfaction was defined as patient who has the pain relief 50%≧

 

  1 week(N=116)

1 month(N=116)

3 months

(N=116)

6 months

(N=108)

9 months(N=58)

1 year(N=43)

worse 0 0 0 0 0 0

0% 21 26 34 48 28 20

0<&<50% 36 34 30 17 14 13

50<=&<100 51 44 39 32 11 7

100% 8 12 13 11 5 3

Improvement rate (%)* 81.90 77.59 70.69 55.56 51.72 53.49

Satisfactory rate (%)* 50.86 48.28 44.83 39.81 27.59 23.26

Table 4. Results after lumbar pulsed radiofrequency stimulation

0%

20%

40%

60%

80%

100%

1 week(N=116)

1 month(N=116)

3 months(N=116)

6 months(N=108)

9 months(N=58)

1 year(N=43)

After Lumbar Pulsed Radiofrequency

Symptom FreeBetterSlightly BetterUnchangedAggravated

Figure 3.

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

Before RF 1 week 1 month 3 months 6 months 9 months 1 year

After Lumbar Pulsed Radiofrequency

Pain Scale

Figure 4. Visual analog pain scale distribution on lumbar patients with improvement ≧ 50% and last for more than 1 month

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%.

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.

Thank you for your attention