EFFECT OF BIPOLAR PULSED RADIOFREQUENCY ON CHRONIC CERVICAL RADICULAR PAIN REFRACTORY TO MONOPOLAR PULSED RADIOFREQUENCY
Authors: Yang, S and Chang M.C
Study type: Prospective, single center
Publication: Ann. Palliat. Med. 2020; 9(2):169-174 (Link to PubMed)
Key Words: Chronic Cervical Radicular Pain – Cervical Dorsal Root Ganglion – Bipolar Pulsed RF
Graph created by Boston Scientific based on the published data
To evaluate the effect of bipolar pulsed radiofrequency (PRF) in patients with chronic cervical radicular pain who were refractory to monopolar PRF and transforaminal epidural steroid injection (TFESI)
Patients: This study recruited 20 patients with chronic cervical radicular pain who were unresponsive to monopolar PRF and TFESI. Patients underwent bipolar PRF of their cervical dorsal root ganglion (DRG).
- Treatment outcomes were evaluated using the Numeric Rating Scale (NRS) for cervical radicular pain before treatment and 1-, 2-, and 3-months post-treatment.
- Successful pain relief was defined as ≥50% reduction in baseline NRS score at 3 months.
- Patient global perceived effect (GPE) was assessed at 3-months post-treatment using a 7-point Likert scale. Patients that reported very good (score 7) or good results (score 6) were considered to be satisfied with the PRF procedure.
Bipolar PRF procedure: PRF stimulation of the cervical DRG was performed under fluoroscopy guidance as follows:
- Insertion of two catheter needles (22-gauge active curved-tip)
- Sensory stimulation with a PRF generator (Cosman G4 Medical™) until the patient reported a tingling sensation and/or dysesthesia at <0.3V.
- PRF treatment: 5Hz and 5-millisecond pulsed width for 360 seconds at 45V
- Electrode tip temperature was maintained at or below 42°C.
- Cervical radicular pain (NRS scores) was significantly reduced at 1, 2, and 3 months post-PRF (P<0.001).
- 50% of the patients (10/20) reported successful pain relief (≥ 50% pain reduction of initial pain) at 3 months post-bipolar PRF of cervical DRG.
- All patients completed the study protocol and did not present with any adverse effect.
Bipolar PRF of the cervical DRG could be considered a safe and effective modality for alleviating refractory chronic cervical radicular pain, especially when TFESI or monopolar PRF fail to achieve a therapeutic benefit.