Ann Rehabil Med.  2011 Dec;35(6):826-832. 10.5535/arm.2011.35.6.826.

Short-Term Effects of Pulsed Radiofrequency on Chronic Refractory Cervical Radicular Pain

• Choi GS
• Ahn SH
• Cho YW
• Lee DK

• KMID: 2266808
• DOI: http://doi.org/10.5535/arm.2011.35.6.826

Abstract

OBJECTIVE
To evaluate the short-term effectiveness of pulsed radiofrequency on the dorsal root ganglion (DRG) in patients with chronic refractory cervical radicular pain. METHOD: Fifteen patients (13 males, 2 females; mean age, 55.9 years) with chronic radicular pain due to cervical disc herniation or foraminal stenosis refractory to active rehabilitative management, including transforaminal cervical epidural steroid injection and exercise, were selected. All patients received pulsed radiofrequency on the symptomatic cervical dorsal root ganglion and were carefully evaluated for neurologic deficits and side effects. The clinical outcomes were measured using a visual analogue scale (VAS) and a neck disability index (NDI) before treatment, one and three months after treatment. Successful pain relief was defined as a 50% or greater reduction in the VAS score as compared with the pre-treatment score. After three months, we categorized the patients' satisfaction.
RESULTS
The average VAS for radicular pain was reduced significantly from 5.3 at pretreatment to 2.5 at 3 months post-treatment (p<0.05). Eleven of 15 patients (77.3%) after cervical pulsed RF stimulation reported pain relief of 50% or more at the 3 month follow-up. The average NDI was significantly reduced from 44.0% at pretreatment to 35.8% 3 months post-treatment (p<0.05). At 3 months post-treatment, eleven of fifteen patients (73.3%) were satisfied with their status. No adverse effects were observed.
CONCLUSION
The results demonstrate that the application of pulsed radiofrequency on DRG might be an effective short-term intervention for chronic refractory cervical radicular pain. Further studies, including a randomized controlled trial with long-term follow-up, are now needed.

Keyword

Pulsed radiofrequency; Cervical radicular pain

MeSH Terms

Constriction, Pathologic
Diagnosis-Related Groups
Follow-Up Studies
Ganglia, Spinal
Humans
Male
Neck
Neurologic Manifestations

Figure

• 

  Fig. 1 These axial T2-weighted magnetic resonance images show an extruded disc (thin line arrow) in the left C5-6 paramedian area (A) and foraminal stenosis due to Luschka joint hypertrophy (thick line arrow) on the Right C6-7 level (B).

• 

  Fig. 2 (A) RF generator, (B) Cannula and Catheter needle, (C, D) Fluoroscopy-guided pulsed radiofrequency of the Right C8 dorsal root ganglion.

• 

  Fig. 3 Scores of the visual analogue scale (VAS) for cervical radicular pain were reduced significantly from 5.3 at pre-treatment to 2.7 at 1 month post-treatment, and to 2.5 at 3 months post-treatment, respectively. *p<0.05: Compared with pre-treatment.

• 

  Fig. 4 Individual changes in visual analogue scale (VAS) scores versus time: pre-treatment, and 1 and 3 months post-treatment.

• 

  Fig. 5 Average Neck disability index (NDI) was reduced significantly from 44.0% at pre-treatment to 35.8% at 3 months post-treatment. *p<0.05: Compared with pre-treatment.

Reference

1. Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study of Rochester, Minnesota, 1976 through 1990. Brain. 1994; 117:325–335. PMID: 8186959.

2. Rathmell JP, Aprill C, Bogduk N. Cervical transforaminal injection of steroids. Anesthesiology. 2004; 100:1595–1600. PMID: 15166582.

3. Merskey H, Bogduk N. Classification of chronic pain. 1994. 2nd ed. Seattle: IASP Press;p. 209–221.

4. Ahlgren B, Garfin S. Cervical radiculopathy. Orthop Clin North Am. 1996; 27:253–263. PMID: 8614578.

5. Takahashi H, Suguro T, Okazima Y, Motegi M, Okada Y, Kakiuchi T. Inflammatoy cytokines in the herniated disc of the lumbar spine. Spine. 1996; 21:218–224. PMID: 8720407.

6. Ahn SH, Cho YW, Ahn MH, Jang SH, Sohn YK, Kim HS. mRNA expression of cytokines and chemokines in herniated lumbar intervertebral discs. Spine. 2002; 27:911–917. PMID: 11979160.

7. Saal JS, Franson RC, Dobrow R, Saal JA, White AH, Goldthwaite N. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine. 1990; 15:674–678. PMID: 2218714.

8. Olmarker K, Byrod G, Cornefjord M, Nordborg C, Rydevik B. Effects of methylprednisolone on nucleus pulposus-induced nerve root injury. Spine. 1994; 19:1803–1808. PMID: 7973978.

9. Shishido H, Kikuchi S, Heckman H, Myers RR. Dexamethasone decreases blood flow in normal nerves and dorsal root ganglia. Spine. 2002; 27:581–586. PMID: 11884905.

10. Cyteval C, Thomas E, Decoux E, Sarrabere MP, Cottin A, Blotman F, Taourel P. Cervical radiculopathy: open study on percutaneous periradicular foraminal steroid infiltration performed under CT control in 30 patients. AJNR Am J Neuroradiol. 2004; 25:441–445. PMID: 15037470.

11. Pagura JR. Percutaneous radiofrequency spinal rhizotomy. Appl Neurophysiol. 1983; 46:138–146. PMID: 6670863.

12. Loeser JD. Dorsal rhizotomy for the relief of chronic pain. J Neurosurg. 1972; 36:745–750. PMID: 5030402.

13. North RB, Kidd DH, Campbell JN, Long DM. Dorsal root ganglionectomy for failed back surgery syndrome: a 5-year follow-up study. J Neurosurg. 1991; 74:236–242. PMID: 1703228.

14. van Wijk RM, Geurts JW, Wynne HJ. Long-lasting analgesic effect of radiofrequency treatment of the lumbosacral dorsal root ganglion. J Neurosurg. 2001; 94(2 Suppl):227–231. PMID: 11302625.

15. Vatansever D, Tekin I, Tuglu I, Erbuyun K, Ok G. A comparison of the neuroablative effects of conventional and pulsed radiofrequency techniques. Clin J Pain. 2008; 24:717–724. PMID: 18806537.

16. Heavner JE, Boswell MV, Racz GB. A comparison of pulsed radiofrequency and continuous radiofrequency on thermocoagulation of egg white in vitro. Pain Physician. 2006; 9:135–137. PMID: 16703974.

17. Sluijter M, Cosman E, Rittman W, van Kleef M. The effects of pulsed radiofrequency field applied to the dorsal root ganglion: a preliminary report. Pain Clinic. 1998; 11:109–117.

18. Van Zundert J, Patijn J, Kessels A, Lame I, van Suijlekom H, van Kleef M. Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: a double blind sham controlled randomized clinical trial. Pain. 2007; 127:173–182. PMID: 17055165.

19. Slipman CW, Lipetz JS, DePalma MJ, Jackson HB. Therapeutic selective nerve root block in the non-surgical treatment of traumatically induced cervical spondylotic radicular pain. Am J Phys Med Rehabil. 2004; 83:446–454. PMID: 15166689.

20. Kobayashi S, Yoshizawa H, Yamada S. Pathology of lumbar nerve root compression. Part 1: Intraradicular inflammatory changes induced by mechanical compression. J Orthop Res. 2004; 22:170–179. PMID: 14656677.

21. Doita M, Kanatani T, Harada T, Mizuno K. Immunohistologic study of the ruptured intervertebral disc of the lumbar spine. Spine. 1996; 21:235–241. PMID: 8720410.

22. Benyamin RM, Singh V, Parr AT, Conn A, Diwan S, Abdi S. Systematic review of the effectiveness of cervical epidurals in the management of chronic neck pain. Pain Physician. 2009; 12:137–157. PMID: 19165300.

23. Slipman CW, Lipetz JS, Jakson HB, Rogers DP, Vresilovic EJ. Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil. 2000; 81:741–746. PMID: 10857517.

24. Saal JS, Saal JA, Yurth EF. Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine. 1996; 21:1877–1883. PMID: 8875719.

25. Arnasson O, Carlsson CA, Pellettieri L. Surgical and conservative treatment of cervical spondylotic radiculopathy and myelopathy. Acta Neurochir (Wien). 1987; 84:48–53. PMID: 3030063.

26. Lees F, Turner JW. Natural history and prognosis of cervical spondylosis. Br Med J. 1963; 2:1607–1610. PMID: 14066179.

27. Mikeladze G, Espinal R, Finnegan R, Routon J, Martin D. Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain. Spine J. 2003; 3:360–362. PMID: 14588947.

28. Chao SC, Lee HT, Kao TH, Yang MY, Tsuei YS, Shen CC, Tsou HK. Percutaneous pulsed radiofrequency in the treatment of cervical and lumbar radicular pain. Surg Neurol. 2008; 70:59–65. PMID: 18207554.

29. Higuchi Y, Nashold BS Jr, Sluijter M, Cosman E, Pearlstein RD. Exposure of the dorsal root ganglion in rats to pulsed radiofrequency currents activates dorsal horn lamina I and II neurons. Neurosurgery. 2002; 50:850–855. PMID: 11904038.

30. van Zundert J, de Louw AJ, Joosten EA, Kessels AG, Honig W, Dederen PJ, Veening JG, Vles JS, van Kleef M. Pulsed and continuos radiofrequency current adjacent to the cervical dorsal root ganglion of the rat induces late cellular activity in the dorsal horn. Anesthesiology. 2005; 102:125–131. PMID: 15618796.