Pulsed Radiofrequency Helpful for Herniated Disk and Spinal Stenosis

From Medscape Medical News
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

May 24, 2007 -- Pulsed radiofrequency is an effective treatment in patients with herniated disk and spinal stenosis but not in those with failed back surgery syndrome (FBSS), according to the results of a retrospective analysis reported in the seventh volume of Pain Practice.

"Radiofrequency (RF) thermolesioning adjacent to the dorsal root ganglion (DRG) has been employed for pain relief in patients with cervicobrachial pain, thoracic radiculopathy, and chronic lumbar radicular pain (LRP)," write David Abejón, MD, FIPP, from Hospital Universitario Clínica Puerta de Hierro in Madrid, Spain, and colleagues.
"Despite its widespread use and well-documented efficacy, this option does not appear to be an ideal modality of treatment for LRP because neurodestructive methods for the treatment of neuropathic pain are in principle generally considered inappropriate.... The purpose of this study was to evaluate the effectiveness of pulsed radiofrequency (PRF) applied to the lumbar dorsal root ganglion."

The investigators performed a retrospective analysis of 54 consecutive patients who underwent 75 pulsed radiofrequency procedures and divided them into 3 groups based on the etiology of the lesion: herniated disk, spinal stenosis, and FBSS.
The analgesic efficacy of the technique was evaluated using a 10-point Numeric Rating Scale (NRS) at baseline and the NRS and Global Perceived Effect (GPE) at 30, 60, 90, and 180 days.
Other outcomes were reduction in medications and number of complications observed.

The NRS and GPE scores decreased in patients with herniated disk ( P < .05) and spinal stenosis ( P < .001) but not in those with FBSS. No complications were observed.

Therapeutic success was defined as a GPE score greater than 5 at 60-day follow-up or a decrease in NRS score of 2 points.
Based on these criteria, the proportion of patients with therapeutic success was 15.3% in FBSS, 66.6% in spinal stenosis, and 72.4% in herniated disk, and the number needed to treat was 6.5, 1.49, and 1.38 patients, respectively.

Study limitations include retrospective design and small sample size.

"We conclude that, in our hands and with our patient population, PRF of DRG yields satisfactory results in patients with HD [herniated disk], and lesser but worthwhile results in patients with SS [spinal stenosis]," the authors write. "PRF of DRG appears to be of no benefit to patients with FBSS."

Pain Pract. 2007;7:21-26.