Abstract
Introduction The incidence of radicular pain that arises without a surgically significant cause of compression is 4.8–10.2 % in the structure of the failed back surgery Pulsed radiofrequency treatment (PRF) is successfully used for several neuropathic pain syndromes, but its effectiveness for postoperative radicular pain has not been studied sufficiently. Materials and methods Prospective non-randomized open study was performed. A group of 56 patients with postoperative radicular pain syndrome was included. Twenty-two patients of the index group underwent PRF treatment of dorsal root ganglia (DRG) in combination with transforaminal epidural steroid injection (TFES) while 34 patients of the control group received only TFES. Outcome of a successful response was defined as a 50 % reduction in numeric rating scale (NRS-11) or 4-points pain reduction and/or a 20 % decrease in the Oswestry Disability Index (ODI), and/or an 8-point decrease in the sciatica bothersomeness index (SBI) from the baseline and the effect duration for six or more months. Dynamics of the decrease in the parameters studied was assessed and compared; a search for significant prognostic factors was carried out. Results Positive results of interventions, based on specified criteria, were obtained in 18 patients (81.82 %) in the index group and in 19 patients (55.88 %) in the control group (significant difference, p = 0.045). There was a significant decrease in all indices after the intervention, a decrease in SBI in the main group was significantly lower than in the control one, p = 0.021. There were no major complications and side effects. The presence of allodynia/hyperpathy was the main negative prognostic factor in the index and in control groups with OR 0.79 at 95 % CI (0.735–0.897) and OR 0.82 at 95 % CI (0.780–0.929), respectively. Conclusion The use of the PRF in combination with TFES is an effective method in comparison with TFES alone for treatment of postsurgical radicular pain syndrome.
Highlights
The incidence of radicular pain that arises without a surgically significant cause of compression is 4.8–10.2 % in the structure of the "failed back surgery syndrome"
The purpose of our study was to evaluate the possibility of using Pulsed radiofrequency treatment (PRF) for treating spinal ganglia in combination with epidural steroid injection (ESI) for management of radicular pain syndrome after surgical interventions for degenerative disease in the lumbosacral spine
The relationship between the clinical outcomes of spinal interventions and the severity of epidural fibrosis according to magnetic resonance imaging (MRI) data has been currently not proven, neither is the importance of methods for its prevention [28-31], the severity of the scar process was not taken into account in the present study
Summary
The incidence of radicular pain that arises without a surgically significant cause of compression is 4.8–10.2 % in the structure of the "failed back surgery syndrome". Pulsed radiofrequency treatment (PRF) is successfully used for several neuropathic pain syndromes, but its effectiveness for postoperative radicular pain has not been studied sufficiently. Persistent or resumed radicular pain after a successful operation without any obvious substratum for a repeated intervention is the basis of the so-called "failed back surgery syndrome" (FBSS). Pulsed radiofrequency ablation (PRF) is a method of pain management which is based on the ultrastructural effect of high frequency current on myelin-free nerve fibers with the simulation of a pain impulse passage. Studies of different levels demonstrate the effectiveness of the method for treatment of pain syndrome of various etiologies, including radiculopathy [13-17]. Patients without surgery in their history were jointly studied [18-22]
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