Effect of bipolar pulsed radiofrequency on refractory chronic cervical radicular pain: A report of two cases

Min Cheol Chang, Min Cheol Chang

Abstract

Rationale: 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.

Patient concerns: 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.

Diagnoses: 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.

Interventions: 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.

Outcomes: 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.

Lessons: Application of bipolar PRF to DRGs seems to be an effective and safe technique for treating refractory chronic cervical radicular pain.

Conflict of interest statement

The author has no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
(A) Patient 1: axial T2-weighted cervical spine MRI at 8 months after symptom onset showed foraminal stenosis at the right C6–7 (right). Bipolar pulsed radiofrequency on the right C7 dorsal root ganglion was performed under the C-arm fluoroscopy (oblique and anteroposterior views) (left). (B) Patient 2: axial T2-weighted cervical spine MRI at 6 months after symptom onset presented with right central to right foraminal disc protrusion on C6–7 (right). Fluoroscopy-guided bipolar pulsed radiofrequency on the right C7 dorsal root ganglion was performed (oblique and anteroposterior views) (left).

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