Pulsed Radiofrequency Helpful for Herniated Disk and Spinal Stenosis


May 24, 2007 — Pulsed radiofrequency is an
effective treatment in patients with herniated disk and spinal stenosis
but not in those with failed back surgery syndrome (FBSS), according
to the results of a retrospective analysis reported in the seventh
volume of Pain Practice.

"Radiofrequency (RF) thermolesioning adjacent to the dorsal root
ganglion (DRG) has been employed for pain relief in patients with
cervicobrachial pain, thoracic radiculopathy, and chronic lumbar
radicular pain (LRP)," write David Abejón, MD, FIPP, from Hospital
Universitario Clínica Puerta de Hierro in Madrid, Spain, and
colleagues. "Despite its widespread use and well-documented efficacy,
this option does not appear to be an ideal modality of treatment for
LRP because neurodestructive methods for the treatment of neuropathic
pain are in principle generally considered inappropriate.... The
purpose of this study was to evaluate the effectiveness of pulsed
radiofrequency (PRF) applied to the lumbar dorsal root ganglion."

The investigators performed a retrospective analysis of 54 consecutive
patients who underwent 75 pulsed radiofrequency procedures and divided
them into 3 groups based on the etiology of the lesion: herniated disk,
spinal stenosis, and FBSS. The analgesic efficacy of the technique was
evaluated using a 10-point Numeric Rating Scale (NRS) at baseline and
the NRS and Global Perceived Effect (GPE) at 30, 60, 90, and 180 days.
Other outcomes were reduction in medications and number of
complications observed.

The NRS and GPE scores decreased in patients with herniated disk (P
< .05) and spinal stenosis (P < .001) but not in those with FBSS.
No complications were observed.

Therapeutic success was defined as a GPE score greater than 5 at 60-day
follow-up or a decrease in NRS score of 2 points. Based on these
criteria, the proportion of patients with therapeutic success was 15.3%
in FBSS, 66.6% in spinal stenosis, and 72.4% in herniated disk, and
the number needed to treat was 6.5, 1.49, and 1.38 patients,
respectively.
Study limitations include retrospective design and small sample size.
"We conclude that, in our hands and with our patient population, PRF of
DRG yields satisfactory results in patients with HD [herniated disk],
and lesser but worthwhile results in patients with SS [spinal
stenosis]," the authors write. "PRF of DRG appears to be of no benefit
to patients with FBSS."

Pain Pract. 2007;7:21-26.

Source: http://www.medscape.com/viewarticle/557174?src=mp

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