Radiofrequency Lesion Adjacent to the Dorsal Root Ganglion for Cervicobrachial Pain: A Prospective Double Blind Randomized Study

Abstract

Each of 20 consecutive patients with a history of at least 1 year of intractable chronic cervicobrachial pain was randomly assigned to one of two treatment groups. The pretreatment investigation included at least three diagnostic segmental nerve blocks in each patient. Each patient in Group 1 received a 67 degrees C radiofrequency lesion adjacent to the dorsal root ganglion. The patients in Group II were treated in an identical manner as those in Group I, except that no actual radiofrequency lesion was made. Neither the therapist nor the patients were aware of the treatment group assignment. All patients were questioned about their pain experience 1 week before and 8 weeks after the procedure. The following tests were used in evaluating patient response: Visual Analogue Scale (VAS); McGill Pain Questionnaire, Dutch Language Version (MPQ-DLV); and Multidimensional Pain Inventory, Dutch Language Version (MPI-DLV). These tests showed that 8 weeks after the procedure, there was a significant number of "successful" patients in Group I compared to Group II (P = 0.0027); there was a significant reduction in VAS score (P < 0.01) and also in parameters measured with MPQ-DLV and MPI-DLV in Group I. This study indicates that a 67 degrees C radiofrequency lesion adjacent to the dorsal root ganglion can result in a significant alleviation of pain in chronic cervicobrachial pain.

The role of radiofrequency in the treatment of mechanical pain of spinal origin

“…Other studies supported these data, including one recently published in the Lancet [1,6,8]. On the other hand, other authors showed long-term improvement in pain even for years after the procedure [4,17,19,22].…”

“…Patients who were suffering LBP and had osteoarthritic changes in their facet joints (facet syndrome) underwent RF ablation of the medial branch of the dorsal ramus [2,9,10,12,14,15,17,19,21,20]. Denervation was performed in an ambulatory outpatients setting under local anesthesia of the superficial tissue layers using 1% lidocaine and with fluoroscopic guidance.…”

“…After sensor stimulation with 50 Hz and motor stimulation with 2 Hz, 0.5 cc of local anesthetic (2% lidocaine) and 80 mg depomedrol were injected. The ablation was done with a core temperature of 80°C around the electrode tip [9,12,17,19]. For ablation of the cervical medial branch we used the postero-lateral approach [18].…”

“…The principle is production of heat in order to damage some or all nerve fibers in the target nervous structure (in the case of "conventional" RF) or application of an electromagnetic field to the nervous structure (in the case of pulsed RF), with the ultimate aim of blocking transmission of pain stimuli from peripheral receptors to the central pain structures. In recent years, some publications have reported contradictory results following RF treatment of back pain [1,4,6,8,17,19,22]. On the one hand, Leclaire et al reported that the procedure is effective in terms of pain improvement only in the short term (4 weeks after the procedure) and the improvement failed to last even beyond 12 weeks [8].…”

Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review

“…Two studies reported some subsiding pain and numbness associated with the procedure [60,92]. The symptoms were more common and lasted longer in the radiofrequency lesion group.…”