Radiofrequency ablation of superior hypogastric ganglion and dorsal root ganglion reduces neuropathic pain in L5-S1 disc anterior protrusion: a case report

Abstract

Approximately 36%-55% of patients with chronic low back pain (LBP) have neuropathic pain syndrome. Prescription of adjuvant analgesics or antidepressants is effective in reducing pain but requires special attention. A female patient, 57 y, presented with complaints of LBP for 5-7 days. Pain was spread bilateral in the hips-groin, as well as to the fingers and soles (NRS 6-8, PainDETECT 35). She had history of falls 10 y ago, but still worked for 5 hours daily. She had allodynia, dysesthesia, hyperalgesia, and L4-5 and L5-S1 hypesthesia. Magnetic resonance imaging (MRI) showed postero-central and lateral bulged L4-5 and L5-S1 discs. Radiofrequency ablation (RFA) 70o of superior hypogastric ganglion for 90 sec, and pulsed radiofrequency (PRF) 42o of dorsal root ganglion (DRG) L4-5, L5-S1 bilaterally for 2 min reduced nociceptive pain (NRS 2-3) and neuropathic pain (PainDETECT 12). Post-surgical medication included levofloxacin, gabapentin, paracetamol, amitriptyline and Vitamin B12. The sympathetic ganglia supply the anterior segments of the lumbar vertebrae and the anterior longitudinal ligament, often overlooked as a cause of pain. The management of LBP patient depends upon the etiology, whether associated to structural abnormalities or nerve dysfunction. Keywords: anterior disc herniation, dorsal root ganglion, lumbar disc herniation, neuropathic pain, superior hypogastric ganglion, radiofrequency Citation: Budisulistyo T. Radiofrequency ablation of superior hypogastric ganglion and dorsal root ganglion reduces neuropathic pain in L5-S1 disc anterior protrusion: a case report. Anaesth. pain intensive care 2024;28(4):757−761; DOI: 10.35975/apic.v28i4.2523 Received: August 02, 2023; Reviewed: December 26, 2023; Accepted: December 26, 2023