Pulsed radiofrequency ablation of dorsal root ganglions in the treatment of postsurgical radicular pain

Introduction The incidence of radicular pain that arises without a surgically significant cause of compression is 4.8–10.2 % in the structure of the "failed back surgery syndrome". Pulsed radiofrequency treatment (PRF) is successfully used for several neuropathic pain syndromes, but its effectiveness for postoperative radicular pain has not been studied sufficiently. Materials and methods Prospective non-randomized open study was performed. A group of 56 patients with postoperative radicular pain syndrome was included. Twenty-two patients of the index group underwent PRF treatment of dorsal root ganglia (DRG) in combination with transforaminal epidural steroid injection (TFES) while 34 patients of the control group received only TFES. Outcome of a successful response was defined as a 50 % reduction in numeric rating scale (NRS-11) or 4-points pain reduction and/or a 20 % decrease in the Oswestry Disability Index (ODI), and/or an 8-point decrease in the sciatica bothersomeness index (SBI) from the baseline and the effect duration for six or more months. Dynamics of the decrease in the parameters studied was assessed and compared; a search for significant prognostic factors was carried out. Results Positive results of interventions, based on specified criteria, were obtained in 18 patients (81.82 %) in the index group and in 19 patients (55.88 %) in the control group (significant difference, p = 0.045). There was a significant decrease in all indices after the intervention, a decrease in SBI in the main group was significantly lower than in the control one, p = 0.021. There were no major complications and side effects. The presence of allodynia/hyperpathy was the main negative prognostic factor in the index and in control groups with OR 0.79 at 95 % CI (0.735–0.897) and OR 0.82 at 95 % CI (0.780–0.929), respectively. Conclusion The use of the PRF in combination with TFES is an effective method in comparison with TFES alone for treatment of postsurgical radicular pain syndrome.

[1]  Статья Редакционная.  Член-корреспондент РАН Николай Донченко: «Внедрение научных разработок и их использование в реальном секторе экономики позволяет нам получать экологически безопасную продукцию животного происхождения» , 2020 .

[2]  E. Woo,et al.  Clinically significant pedicle screw malposition is an underestimated cause of radiculopathy. , 2017, The spine journal : official journal of the North American Spine Society.

[3]  K. Song,et al.  Neuropathic Pain after Spinal Surgery , 2017, Asian spine journal.

[4]  L. Webster,et al.  Treatment Options for Failed Back Surgery Syndrome Patients With Refractory Chronic Pain: An Evidence Based Approach , 2017, Spine.

[5]  P. Staats,et al.  Clinical Evidence for Spinal Cord Stimulation for Failed Back Surgery Syndrome (FBSS): Systematic Review , 2017, Spine.

[6]  T. Peters,et al.  Systematic review of management of chronic pain after surgery , 2017, The British journal of surgery.

[7]  F. Wilson,et al.  The aetiologies of Failed Back Surgery Syndrome: A systematic review. , 2017, Journal of back and musculoskeletal rehabilitation.

[8]  K. Song,et al.  Treatment Outcomes for Patients with Failed Back Surgery. , 2017, Pain physician.

[9]  В. Х. Тимербаев,et al.  Успешное применение импульсной радиочастотной абляции ганглиев спинномозговых нервов при лечении пациента с хронической нейропатической болью в культе ампутированной конечности , 2016 .

[10]  Д. В. Заболотский,et al.  ПРИМЕНЕНИЕ ИМПУЛЬСНОЙ РАДИОЧАСТОТНОЙ АБЛЯЦИИ ПРИ ЛЕЧЕНИИ ТЯЖЕЛОГО ХРОНИЧЕСКОГО БОЛЕВОГО СИНДРОМА ПОСЛЕ ЭНДОПРОТЕЗИРОВАНИЯ ПЛЕЧЕВОГО СУСТАВА (КЛИНИЧЕСКИЙ СЛУЧАЙ) , 2015 .

[11]  Young Ki Kim,et al.  Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: a randomized controlled study. , 2015, Pain medicine.

[12]  L. Thabane,et al.  Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: a randomized, placebo-controlled pilot study , 2014, Journal of pain research.

[13]  S. Thomson.  Failed back surgery syndrome – definition, epidemiology and demographics , 2013, British journal of pain.

[14]  L. Manchikanti,et al.  Assessment of effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial , 2012, Journal of pain research.

[15]  L. Manchikanti,et al.  Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Control Trial , 2012, International journal of medical sciences.

[16]  Ramsin M. Benyamin,et al.  Percutaneous adhesiolysis in the management of chronic low back pain in post lumbar surgery syndrome and spinal stenosis: a systematic review. , 2012, Pain physician.

[17]  Эдуард Валерьевич Гончарук.  Лечение больного с сочетанной травмой и разрывом диафрагмы (случай из практики) , 2012 .

[18]  G. Andersson,et al.  Comparative Effectiveness Evidence From the Spine Patient Outcomes Research Trial: Surgical Versus Nonoperative Care for Spinal Stenosis, Degenerative Spondylolisthesis, and Intervertebral Disc Herniation , 2011, Spine.

[19]  S. Mlyavykh,et al.  An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. , 2011, Pain physician.

[20]  M. van Kleef,et al.  Pulsed radiofrequency treatment adjacent to the lumbar dorsal root ganglion for the management of lumbosacral radicular syndrome: a clinical audit. , 2011, Pain medicine.

[21]  Екатерина Викторовна Бандурина,et al.  Использование метода Стрейн-Контрстрейн в реабилитации больных с миофасциальным болевым синдромом пояснично-крестцового отдела позвоночника , 2011 .

[22]  J. Henderson,et al.  Spinal Cord Stimulation Versus Re‐operation in Patients With Failed Back Surgery Syndrome: An International Multicenter Randomized Controlled Trial (EVIDENCE Study) , 2011, Neuromodulation : journal of the International Neuromodulation Society.

[23]  P. Peng,et al.  Failed back surgery syndrome. , 2011, Pain medicine.

[24]  K. Vissers,et al.  Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications—a review , 2010, Acta Neurochirurgica.

[25]  Constantin Schizas,et al.  Qualitative Grading of Severity of Lumbar Spinal Stenosis Based on the Morphology of the Dural Sac on Magnetic Resonance Images , 2010, Spine.

[26]  Heung Sik Kang,et al.  A practical MRI grading system for lumbar foraminal stenosis. , 2010, AJR. American journal of roentgenology.

[27]  Brian E. Harrington,et al.  От редакции журнала «Регионарная анестезия и лечение острой боли» , 2010 .

[28]  Wei Gong,et al.  Percutaneous pulsed radiofrequency applied to the L-2 dorsal root ganglion for treatment of chronic low-back pain: 3-year experience , 2010 .

[29]  L. Manchikanti,et al.  A comparative effectiveness evaluation of percutaneous adhesiolysis and epidural steroid injections in managing lumbar post surgery syndrome: a randomized, equivalence controlled trial. , 2009, Pain physician.

[30]  H. Brisby,et al.  Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients , 2008, European Spine Journal.

[31]  R. Ramina,et al.  Outcome following lumbar disc surgery: the role of fibrosis , 2008, Acta Neurochirurgica.

[32]  Chiung-Chyi Shen,et al.  Percutaneous pulsed radiofrequency in the treatment of cervical and lumbar radicular pain. , 2008, Surgical neurology.

[33]  E. Buchser,et al.  Spinal cord stimulation versus conventional medical management for neuropathic pain: A multicentre randomised controlled trial in patients with failed back surgery syndrome , 2007, Pain.

[34]  G. Afshan,et al.  Use of pulsed radiofrequency in failed back surgery syndrome. , 2007, Journal of the College of Physicians and Surgeons--Pakistan : JCPSP.

[35]  D. Abejón,et al.  Pulsed Radiofrequency in Lumbar Radicular Pain: Clinical Effects in Various Etiological Groups , 2007, Pain practice : the official journal of World Institute of Pain.

[36]  J. Patijn,et al.  Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: A double blind sham controlled randomized clinical trial , 2007, Pain.

[37]  M. van Kleef,et al.  Pulsed radiofrequency: current clinical and biological literature available. , 2006, Pain medicine.

[38]  M. Sluijter,et al.  Pulsed Radiofrequency for Radicular Pain Due to a Herniated Intervertebral Disc—An Initial Report , 2005, Pain practice : the official journal of World Institute of Pain.

[39]  C. Pfirrmann,et al.  MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. , 2004, Radiology.

[40]  E. Buskens,et al.  Radiofrequency lesioning of dorsal root ganglia for chronic lumbosacral radicular pain: a randomised, double-lind, controlled trial , 2003, The Lancet.

[41]  P. Parizel,et al.  The postoperative spine , 1996 .