Clin Surg | Volume 5, Issue 1 | Research Article | Open Access

Chronic Lumbosacral Painful Unilateral Radiculopathy: Dorsal Root Ganglion Pulsed Radiofrequency vs. Transforaminal Epidural Steroid Injection: A Prospective Randomized Study

Mihails Arons1*, Eva Strīķe2, Māra Pilmane3, Edgars Vasiļevskis3, Irina Evansa1, Igors Paņihins2 and Jekaterina Logasina4

1Department of Anesthesiology and Intensive Care, Riga Stradins University, Riga, Latvia
2Department of Anesthesiology and Intensive Care, Pauls Stradins Clinical University Hospital, Riga, Latvia
3Department of Morphology, Riga Stradins University, Institute of Anatomy and Anthropology, Riga, Latvia
4Department of Anesthesiology, Riga Eastern Clinical University Hospital, Intensive Care Unit, Riga, Latvia

*Correspondance to: Mihails Arons 

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Abstract

Background: Pulsed Radiofrequency (PRF) procedures are a minimally invasive and target-selective modality procedure. PRF procedure becoming an increasingly used treatment for chronic radicular pain and competitive with Transforaminal Epidural Steroid Injection (TFESI). Methods: A prospective randomized, blind study was performed to evaluate the therapeutic effect of lumbar Dorsal Root Ganglion (DRG) PRF treatment and lumbar TFESI and to compare efficacy of these two techniques, on the patient with chronic unilateral lumbosacral radicular pain with radiculopathy. The study included a total of 72 patients, of whom 35 were randomized to PRF group, 35 patients - to TFESI group, and 2 patients received placebo. The outcome of the treatment either by PRF or TFESI was evaluated by Global Perceiving Effect (GPE) and decrease in NRS and ODQ at day 30, 60 and 180. After 30th day follow-up, patients with GPE Likert scores ≤ 5 had received the second, identical procedure. Results: GPE increased with time for both PRF and TFESI groups, reached at day 180 follow-up 6.2 for PRF and 6.3 for TFESI. Statistical comparison of improvements, caused by PRF and TFESI does not revealed significant difference in the treatment outcomes, i.e. generally values of GPE, decrease of NRS and decrease of ODQ was similar for PRF and TFESI treatments during entire follow up period. The only exception was decrease in ODQ scale at the day 30 that was higher for PRF treatment (P-value 0.02). Alongside, in PRF group there was only 9% of patients with less than 20% improvement in disability, as compared with 29% in TFESI group. But at the day 180, the proportion of patient with pain reduction more than 60% in TFESI group exceeded one for PRF group. Conclusion: The effectiveness of DRG PRF and TFESI by evaluation of three assessment’s tools: GPE, NRS and ODQ demonstrates the efficiency of the PRF in short-term response (30 days followup) due to the notably higher decrease in ODQ scores in PRF than into the TFESI group, despite of similar GPE and NRS scores in both groups. TFESI procedure is more effective in long-term perspective, proved by slightly higher proportion of patients with pain reduction.

Keywords:

Pulsed radiofrequency; Chronic lumbosacral radiculopathy; Dorsal root ganglion;
Epidural steroid injection

Citation:

Arons M, Strīķe E, Pilmane M, Vasiļevskis E, Evansa I, Paņihins I, et al. Chronic Lumbosacral Painful Unilateral Radiculopathy: Dorsal Root Ganglion Pulsed Radiofrequency vs. Transforaminal Epidural Steroid Injection: A Prospective Randomized Study. Clin Surg. 2020; 5: 2759..

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