EFFECTIVENESS OF ULTRASOUND-GUIDED PULSED RADIOFREQUENCY TREATMENT IN PATIENTS WITH REFRACTORY CHRONIC CERVICAL RADICULAR PAIN
Authors: Lee S.H, Choi H.H, Roh E.Y and Chang M.C
Study type: Prospective, single center
Publication: Pain Physician 2020; 23(3):E265-E272 (Link to PubMed)
Key Words: Chronic Cervical Radicular Pain – Cervical Facet Joint – Pulsed RF
Graphs created by Boston Scientific based on the published data.
To evaluate the effectiveness of PRF with ultrasound (US) guidance in patients with chronic cervical radicular pain unresponsive to repeated transforaminal epidural steroid injections (TFESIs)
Patients: The study included 49 consecutive patients diagnosed with cervical radicular pain with, at least, 6 months history of segmental pain radiating to the arm. Patients were refractory to repeated TFESIs. 19 patients had HCD (herniated cervical disc) and 30 had CFS (cervical foraminal stenosis) induced by facet joint hypertrophy.
NRS-11 (Numeric Rating Scale) pain scores and Neck Disability Index (NDI) were evaluated at pretreatment and up to 6 months posttreatment. Successful pain relief was defined as ≥ 50% reduction in NRS-11 score vs pretreatment score.
PRF procedure: Target nerve identification and PRF catheter insertion (between the C7 spinal nerve and C7 posterior tubercle) were performed under US guidance. Sensory stimulation was performed with an RF generator (Cosman-G4) until pain was reported (<0.3 V). PRF was administered at 5 Hz, 5ms PW, and 45 V for 360 seconds, at a maximum 42°C.
- NRS-11 scores were significantly reduced (p<0.05) at 1, 3 and, 6 months following PRF treatment, for both HCD and CFS. Patients’ functional disability also decreased significantly at 6 months
- 63.3% of the patients showed successful pain relief (≥ 50% pain reduction of initial pain) with US-guided PRF treatment.
- Overall, this study showed positive therapeutic outcomes regardless of pain etiology (HCD or CFS).
PRF stimulation under the guidance of US is a potentially effective treatment method for managing refractory chronic cervical radicular pain.