The effect of needle tip position on the analgesic efficacy of pulsed radiofrequency treatment in patients with chronic lumbar radicular pain: a retrospective observational study

Won-Joong Kim, Hahck Soo Park, Min Ki Park, Won-Joong Kim, Hahck Soo Park, Min Ki Park

Abstract

Background: Pulsed radiofrequency (PRF) is a treatment modality that alleviates radicular pain by intermittently applying high-frequency currents adjacent to the dorsal root ganglion. There has been no comparative study on analgesic effect according to the position of the needle tip in PRF treatment. The objective of this study is to evaluate the clinical outcomes of PRF according to the needle tip position.

Methods: Patients were classified into 2 groups (group IP [group inside of pedicle] and group OP [group outside of pedicle]) based on needle tip position in the anteroposterior view of fluoroscopy. In the anteroposterior view, the needle tip was advanced medially further than the lateral aspect of the corresponding pedicle in group IP; however, in group OP, the needle tip was not advanced. The treatment outcomes and pain scores were evaluated at 4, 8, and 12 weeks after applying PRF.

Results: At 4, 8, and 12 weeks, there were no significant differences between the successful response rate and numerical rating scale score ratio.

Conclusions: The analgesic efficacy of PRF treatment did not differ with the needle tip position.

Keywords: Analgesics; Ganglia, Spinal; Low Back Pain; Lumbosacral Region; Needles; Pulsed Radiofrequency Treatment; Radiculopathy; Spinal Nerve Roots.

Conflict of interest statement

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Determination of the dorsal root ganglion (DRG) position. A and B are lines connecting the medial and lateral borders of the pedicles, respectively. If the midpoint of the DRG lies proximal to A, it is intraspinal type. If it is between A and B, it is foraminal type. If it is distal to B, it is extraforaminal type.
Fig. 2
Fig. 2
Position of the needle tip. (A) The needle tip was advanced medially further than the lateral aspect of the corresponding pedicle. (B) The needle tip was in the lateral aspect of the corresponding pedicle. P: pedicle.
Fig. 3
Fig. 3
Flow diagram of the patient inclusion process. MRI: magnetic resonance imaging, PRF: pulsed radiofrequency, DRG: dorsal root ganglion, Group IP: group inside of pedicle, Group OP: group outside of pedicle.
Fig. 4
Fig. 4
Numerical rating scale (NRS). Group IP: group inside of pedicle, Group OP: group outside of pedicle. *P < 0.05 relative to baseline.

References

    1. Abejón D, Garcia-del-Valle S, Fuentes ML, Gómez-Arnau JI, Reig E, van Zundert J. Pulsed radiofrequency in lumbar radicular pain: clinical effects in various etiological groups. Pain Pract. 2007;7:21–6. doi: 10.1111/j.1533-2500.2007.00105.x.
    1. Munglani R. The longer term effect of pulsed radiofrequency for neuropathic pain. Pain. 1999;80:437–9. doi: 10.1016/S0304-3959(98)00183-3.
    1. Sluijter ME, Teixeira A, Van Duijn B. Comment on: Erdine S et al.; ultrastructural changes in axons following exposure to pulsed radiofrequency fields. Pain Pract. 2010;10:262. doi: 10.1111/j.1533-2500.2010.00387_1.x.
    1. Kobayashi S, Yoshizawa H, Yamada S. Pathology of lumbar nerve root compression. part 2: morphological and immunohistochemical changes of dorsal root ganglion. J Orthop Res. 2004;22:180–8. doi: 10.1016/S0736-0266(03)00132-3.
    1. Sugawara O, Atsuta Y, Iwahara T, Muramoto T, Watakabe M, Takemitsu Y. The effects of mechanical compression and hypoxia on nerve root and dorsal root ganglia. an analysis of ectopic firing using an in vitro model. Spine (Phila Pa 1976) 1996;21:2089–94. doi: 10.1097/00007632-199609150-00006.
    1. Shen J, Wang HY, Chen JY, Liang BL. Morphologic analysis of normal human lumbar dorsal root ganglion by 3D MR imaging. AJNR Am J Neuroradiol. 2006;27:2098–103.
    1. Lee IS, Kim SH, Lee JW, Hong SH, Choi JY, Kang HS, et al. Comparison of the temporary diagnostic relief of transforaminal epidural steroid injection approaches: conventional versus posterolateral technique. AJNR Am J Neuroradiol. 2007;28:204–8.
    1. Kim DH, Kim YC, Kim KH. Minimally invasive percutaneous spinal techniques. Philadelphia: Saunders Elsevier; 2011. pp. 143–6.
    1. Wolff AP, Groen GJ, Wilder-Smith OH. Influence of needle position on lumbar segmental nerve root block selectivity. Reg Anesth Pain Med. 2006;31:523–30. doi: 10.1097/00115550-200611000-00009.
    1. Gallizzi M, Gagnon C, Harden RN, Stanos S, Khan A. Medication quantification scale version III: internal validation of detriment weights using a chronic pain population. Pain Pract. 2008;8:1–4. doi: 10.1111/j.1533-2500.2007.00163.x.
    1. Kim SJ, Park SJ, Yoon DM, Yoon KB, Kim SH. Predictors of the analgesic efficacy of pulsed radiofrequency treatment in patients with chronic lumbosacral radicular pain: a retrospective observational study. J Pain Res. 2018;11:1223–30. doi: 10.2147/JPR.S164414.
    1. Das B, Conroy M, Moore D, Lysaght J, McCrory C. Human dorsal root ganglion pulsed radiofrequency treatment modulates cerebrospinal fluid lymphocytes and neuroinflammatory markers in chronic radicular pain. Brain Behav Immun. 2018;70:157–65. doi: 10.1016/j.bbi.2018.02.010.
    1. Howe JF, Loeser JD, Calvin WH. Mechanosensitivity of dorsal root ganglia and chronically injured axons: a physiological basis for the radicular pain of nerve root compression. Pain. 1977;3:25–41. doi: 10.1016/0304-3959(77)90033-1.
    1. 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. doi: 10.1016/S1529-9430(03)00065-2.
    1. Bogduk N. Pulsed radiofrequency. Pain Med. 2006;7:396–407. doi: 10.1111/j.1526-4637.2006.00210.x.
    1. Chao SC, Lee HT, Kao TH, Yang MY, Tsuei YS, Shen CC, et al. Percutaneous pulsed radiofrequency in the treatment of cervical and lumbar radicular pain. Surg Neurol. 2008;70:59–65. doi: 10.1016/j.surneu.2007.05.046.
    1. Simopoulos TT, Kraemer J, Nagda JV, Aner M, Bajwa ZH. Response to pulsed and continuous radiofrequency lesioning of the dorsal root ganglion and segmental nerves in patients with chronic lumbar radicular pain. Pain Physician. 2008;11:137–44.
    1. Hasegawa T, Mikawa Y, Watanabe R, An HS. Morphometric analysis of the lumbosacral nerve roots and dorsal root ganglia by magnetic resonance imaging. Spine (Phila Pa 1976) 1996;21:1005–9. doi: 10.1097/00007632-199605010-00001.
    1. Hasue M, Kunogi J, Konno S, Kikuchi S. Classification by position of dorsal root ganglia in the lumbosacral region. Spine (Phila Pa 1976) 1989;14:1261–4. doi: 10.1097/00007632-198911000-00021.
    1. Hamanishi C, Tanaka S. Dorsal root ganglia in the lumbosacral region observed from the axial views of MRI. Spine (Phila Pa 1976) 1993;18:1753–6. doi: 10.1097/00007632-199310000-00006.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit