[Pain Management] Percutaneous pulsed radiofrequency applied to the L-2 dorsal root ganglion for treatment of chronic low-back pain: 3-year experience

[Justin]

Journal of Neurosurgery: Spine, Feb 2010, Vol. 12, No. 2, Pages 190-196

Percutaneous pulsed radiofrequency applied to the L-2 dorsal root ganglion for treatment of chronic low-back pain: 3-year experience

Hsi-Kai Tsou, M.D.1,2,3,4, Shao-Ching Chao, M.D.1, Chao-Jan Wang, M.D.5, Hsien-Te Chen, M.D.6, Chiung-Chyi Shen, M.D.1, Hsu-Tung Lee, M.D.1, and Yuang-Seng Tsuei, M.D.1. 1Department of Neurosurgery, Taichung Veterans General Hospital; 2Division of Neurosurgery, Shun-Tain Hospital; 3Department of Materials Science and Engineering, Feng Chia University, Taichung; 4Center for General Education, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County; 5Division of Neurosurgery, Wei Gong Memorial Hospital, Miaoli County; and 6Department of Orthopaedic Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China. ©1944-2010 by the American Association of Neurosurgeons

Object
The authors assessed the effectiveness of percutaneous pulsed radiofrequency treatment for providing pain relief in patients with chronic low-back pain with or without lower-limb pain.

Methods
Data were obtained in 127 patients who had chronic low-back pain with or without lower-limb pain due to a herniated intervertebral disc or previous failed back surgery and who underwent pulsed radiofrequency treatment. Their conditions were proven by clinical features, physical examination, and imaging studies. Low-back pain was treated with pulsed radiofrequency applied to the L-2 dorsal root ganglion (DRG) and lower-limb pain was treated with pulsed radiofrequency applied to the L3–S1 DRG. Patients underwent uni- or bilateral treatment depending on whether their low-back pain was unilateral or bilateral. A visual analog scale was used to assess pain. The patients were followed up for 3 years postoperatively.

Results
In patients without lower-limb pain (Group A), 27 (55.10%) of 49 patients had initial improvement ≥ 50% at 3-month follow-up. At 1-year follow-up, 20 (44.44%) of 45 patients in Group A had pain relief ≥ 50%. An analysis of patients with pain relief ≥ 50% for at least 1 month showed that the greatest effect was at 3 months after treatment. In patients with low-back pain and lower-limb pain (Group B), 37 (47.44%) of 78 patients had initial improvement ≥ 50% at 3-month follow-up. At 1-year follow-up, 34 (45.95%) of 74 patients had pain relief effect ≥ 50%. An analysis of patients in Group B with pain relief ≥ 50% for at least 1 month showed that the greatest effect was at 1 month after treatment.

Conclusions
The results of this prospective analysis showed that treatment with pulsed radiofrequency applied at the L-2 DRG is safe and effective for treating for chronic low-back pain. Satisfactory pain relief was obtained in the majority of patients in Group A with the effect persisting for at least 3 months. The results indicate that pulsed radiofrequency provided intermediate-term relief of low-back pain. Further studies with long-term follow-up are necessary.

percutaneous pulsed radiofrequency; L-2 dorsal root ganglion; chronic low-back pain.

[mark-Perth]

This is definately worth a try before surgery. I had it done the first time in 1997 or 1998 and then nearly 20 times since.

It didnt last as long as the article did at first with it lasting only a month but with every burn the time become longer and lasting years in the end.

It never got rid of all the pain but it did ease the pain enough for me to be able to exercise and strengthen up and get back on with life for a while but it is only masking the pain, it does nothing to solve the problems.

There is also proof that the L1 nerve is also worth burning as well as sometimes the T12 nerve due to the changes in peoples anatomy. In the end I would just get the left and right of all 3 done at the same time but that wasnt the usual way as 6 burns at once isnt the best, especially as U have to be awake for these ones as the nerve has both movement and feeling to it.

It was done with plain R/F heat originally but I have had both pulse and heat done over the last few yrs and prefer the heat. I find the pulse is like being tazered! Real great fun for the person doing it

My PS also said he gets better results with the heat but the pulse is more accurate so is used on the first attempt as standard now. He uses heat mainly just on the patients that have had it previously and know about it.

Its not much different to a RF facet block in terms of what they R doing and pain wise after so pretty minor really, just a day or 2 with alittle pain. The 3rd day I would wake feeling great.

Mark