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Comparison of the Efficacy of Dorsal Root Ganglion Pulsed Radiofrequency for 2 Minutes versus 4 Minutes in the Treatment of Chronic Lumbosacral Radicular Pain

Yıl 2024, Cilt: 6 Sayı: 3, 313 - 320, 14.10.2024
https://doi.org/10.52827/hititmedj.1491642

Öz

Objective: Pulsed radiofrequency treatment of the dorsal root ganglion has been increasingly used to treat lumbosacral radicular pain in recent decades. However, there is no consensus in the literature regarding issues such as pulsed radiofrequency application duration. This study aimed to determine the efficacy and incidence of adverse events between 2-minute and 4-minute pulsed radiofrequency for lumbosacral radicular pain.
Material and Method: This retrospective study included 160 patients who underwent 2-minute or 4-minute dorsal root ganglion pulsed radiofrequency treatment (Group-2 minutes 82 patients and Group-4 minutes 78 patients). The Numeric Rating Scale and Oswestry Disability Index scores before, 1 and 6 months after the interventions were evaluated to assess the effectiveness of the procedures. The rate of intervention-related adverse events was determined for both durations.
Results: Both the 2-minute and 4-minute procedures provided effective analgesia at 1 and 6 months compared with baseline. There was no difference in the pain scores between the two groups at the measurement times. At the 1-month follow-up, 50% or greater pain relief was achieved in 39% of patients in the 2-minute group compared to 50% in the 4-minute group, with no difference between the groups. There was no significant difference in the rate of procedure-related adverse events between the groups.
Conclusion: Although a higher success rate was achieved with 4-minute pulsed radiofrequency, there was no significant difference, and both 2 and 4-minute pulsed radiofrequency procedures provided safe and effective analgesia compared with baseline. Prospective studies with larger sample sizes are needed.

Etik Beyan

Approval was obtained from the Ankara Etlik City Hospital ethics committee (Date: 12.07.2023; Decision number: AEŞH-EK1-2023-235).

Kaynakça

  • Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol 2010;24:769-781.
  • Urits I, Burshtein A, Sharma M, et al. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep 2019;23:23.
  • Khorami AK, Oliveira CB, Maher CG, et al. Recommendations for Diagnosis and Treatment of Lumbosacral Radicular Pain: A Systematic Review of Clinical Practice Guidelines. J Clin Med 2021;10:2482.
  • Oliveira CB, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev 2020;4:Cd013577.
  • Williams AL, Leggit JC. Epidural Corticosteroid Injections for Lumbosacral Radicular Pain. Am Fam Physician 2021;103:405- 406.
  • Yıldız G, Çelik Ş, Akçaboy EY, et al. Evaluation of the efficacy of pulsed radiofrequency therapy in patients with lumbosacral radicular pain: An analysis of single-center data. Agri 2024;36:38-44.
  • Van Boxem K, de Meij N, Kessels A, Van Kleef M, Van Zundert J. Pulsed radiofrequency for chronic intractable lumbosacral radicular pain: a six-month cohort study. Pain Med 2015;16:1155- 1162.
  • Van Boxem K, van Bilsen J, de Meij N, et al. Pulsed radiofrequency treatment adjacent to the lumbar dorsal root ganglion for the management of lumbosacral radicular syndrome: a clinical audit. Pain Med 2011;12:1322-1330.
  • Koh W, Choi SS, Karm MH, et al. Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: a randomized controlled study. Pain Med 2015;16:432-441.
  • Pastrak M, Visnjevac O, Visnjevac T, Ma F, Abd-Elsayed A. Safety of Conventional and Pulsed Radiofrequency Lesions of the Dorsal Root Entry Zone Complex (DREZC) for Interventional Pain Management: A Systematic Review. Pain Ther 2022;11:411-445.
  • Park SW, Shin YS, Kim HJ, Lee JH, Shin JS, Ha IH. The dischargeable cut-off score of Oswestry Disability Index (ODI) in the inpatient care for low back pain with disability. Eur Spine J 2014;23:2090-2096.
  • McKay SM, McLachlan EM. Inflammation of rat dorsal root ganglia below a mid-thoracic spinal transection. Neuroreport 2004;15:1783-1786.
  • Nagda JV, Davis CW, Bajwa ZH, Simopoulos TT. Retrospective review of the efficacy and safety of repeated pulsed and continuous radiofrequency lesioning of the dorsal root ganglion/ segmental nerve for lumbar radicular pain. Pain Physician 2011;14:371-376.
  • Erdine S, Yucel A, Cimen A, Aydin S, Sav A, Bilir A. Effects of pulsed versus conventional radiofrequency current on rabbit dorsal root ganglion morphology. Eur J Pain 2005;9:251-256.
  • Tun K, Cemil B, Gurcay AG, et al. Ultrastructural evaluation of Pulsed Radiofrequency and Conventional Radiofrequency lesions in rat sciatic nerve. Surg Neurol 2009;72:496-500.
  • Abejón D, Garcia-del-Valle S, Fuentes ML, Gómez-Arnau JI, Reig E, van Zundert J. Pulsed radiofrequency in lumbar radicular pain: clinical effects in various etiological groups. Pain Pract 2007;7:21-26.
  • Türkyılmaz GG. Factors associated with treatment success after combined transforaminal epidural steroid injection and dorsal root ganglion pulsed radiofrequency treatment in patients with chronic lumbar radicular pain. Turk J Med Sci 2022;52:1241-1248.
  • Vigneri S, Sindaco G. Efficacy of High-Voltage Pulsed Radiofrequency in Chronic Lumbosacral Radicular Pain: An Improved Tool? Neuromodulation 2024;27:217.
  • Van Boxem K, de Meij N, Patijn J, et al. Predictive Factors for Successful Outcome of Pulsed Radiofrequency Treatment in Patients with Intractable Lumbosacral Radicular Pain. Pain Med 2016;17:1233-1240.
  • Kim SJ, Park SJ, Yoon DM, Yoon KB, Kim SH. Predictors of the analgesic efficacy of pulsed radiofrequency treatment in patients with chronic lumbosacral radicular pain: a retrospective observational study. J Pain Res 2018;11:1223-1230.

Kronik Lumbosakral Radiküler Ağrı Tedavisinde Dorsal Kök Gangliyonu Darbeli Radyofrekansın 2 Dakikaya Karşı 4 Dakika Süreyle Uygulanmasının Etkinliğinin Karşılaştırılması

Yıl 2024, Cilt: 6 Sayı: 3, 313 - 320, 14.10.2024
https://doi.org/10.52827/hititmedj.1491642

Öz

Amaç: Dorsal kök ganglionunun (DKG) darbeli radyofrekans (DRF) tedavisi, son yıllarda lumbosakral radiküler ağrının (LRA) tedavisinde giderek daha fazla kullanılmaktadır. Ancak DRF uygulama süresi gibi konularda literatürde bir fikir birliği bulunmamaktadır. Bu çalışmanın amacı 2 dakikalık ve 4 dakikalık DRF uygulamaları arasındaki etkinliği ve yan etki insidansını belirlemektir.
Gereç ve Yöntem: Bu retrospektif çalışmaya 2 dakikalık veya 4 dakikalık DKG DRF tedavisi uygulanan 160 hasta dahil edildi (Grup-2 dakika 82 hasta ve Grup-4 dakika 78 hasta). İşlemlerin etkinliğini Amaç: Dorsal kök ganglionunun pulsed radyofrekans tedavisi, son yıllarda lumbosakral radiküler ağrının tedavisinde giderek daha fazla kullanılmaktadır. Ancak pulsed radyofrekansın uygulama süresi gibi konularda literatürde bir fikir birliği bulunmamaktadır. Bu çalışmanın amacı lumbosakral radiküler ağrı tedavisinde 2 dakikalık ve 4 dakikalık pulsed radyofrekans uygulamaları arasındaki etkinliği ve yan etki insidansını karşılaştırmaktır.
Gereç ve Yöntem: Bu retrospektif çalışmaya 2 dakikalık veya 4 dakikalık dorsal kök ganglionu pulsed radyofrekans tedavisi uygulanmış 160 hasta dahil edildi (Grup-2 dakika 82 hasta ve Grup-4 dakika 78 hasta). İşlemlerin etkinliğini değerlendirmek için girişimlerden önce ve girişimlerden 1 ve 6 ay sonra Sayısal Derecelendirme Ölçeği ve Oswestry Engellilik İndeksi skorları değerlendirildi. Girişimlere bağlı advers olayların oranı her iki prosedür için de değerlendirildi.
Bulgular: Hem 2 dakikalık hem de 4 dakikalık pulsed radyofrekans prosedürleri, başlangıca kıyasla 1. ve 6. aylarda etkin analjezi sağladı. Ölçüm zamanlarında iki grup arasında ağrı skorları arasında fark yoktu. 1 aylık takipte, 2 dakika grubundaki hastaların %39’unda, 4 dakika grubundaki hastaların %50’sinde %50 veya daha fazla ağrı rahatlaması sağlandı ve gruplar arasında fark yoktu. Ayrıca işleme bağlı advers olay oranı açısından gruplar arasında anlamlı bir fark yoktu.
Sonuç: Her ne kadar 4 dakikalık pulsed radyofrekans ile daha yüksek bir başarı oranı elde edilmiş olsa da, gruplar arasında anlamlı bir fark yoktu ve hem 2 hem de 4 dakikalık dorsal kök ganglionu pulsed radyofrekans tedavisi, başlangıca kıyasla güvenli ve etkili analjezi sağladı. Daha geniş katılımlı prospektif çalışmalara ihtiyaç vardır.

Etik Beyan

Ankara Etlik Şehir Hastanesi etik kurulundan onay alınmıştır (Tarih: 12.07.2023; Karar numarası: AEŞH-EK1-2023-235).

Kaynakça

  • Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol 2010;24:769-781.
  • Urits I, Burshtein A, Sharma M, et al. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep 2019;23:23.
  • Khorami AK, Oliveira CB, Maher CG, et al. Recommendations for Diagnosis and Treatment of Lumbosacral Radicular Pain: A Systematic Review of Clinical Practice Guidelines. J Clin Med 2021;10:2482.
  • Oliveira CB, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev 2020;4:Cd013577.
  • Williams AL, Leggit JC. Epidural Corticosteroid Injections for Lumbosacral Radicular Pain. Am Fam Physician 2021;103:405- 406.
  • Yıldız G, Çelik Ş, Akçaboy EY, et al. Evaluation of the efficacy of pulsed radiofrequency therapy in patients with lumbosacral radicular pain: An analysis of single-center data. Agri 2024;36:38-44.
  • Van Boxem K, de Meij N, Kessels A, Van Kleef M, Van Zundert J. Pulsed radiofrequency for chronic intractable lumbosacral radicular pain: a six-month cohort study. Pain Med 2015;16:1155- 1162.
  • Van Boxem K, van Bilsen J, de Meij N, et al. Pulsed radiofrequency treatment adjacent to the lumbar dorsal root ganglion for the management of lumbosacral radicular syndrome: a clinical audit. Pain Med 2011;12:1322-1330.
  • Koh W, Choi SS, Karm MH, et al. Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: a randomized controlled study. Pain Med 2015;16:432-441.
  • Pastrak M, Visnjevac O, Visnjevac T, Ma F, Abd-Elsayed A. Safety of Conventional and Pulsed Radiofrequency Lesions of the Dorsal Root Entry Zone Complex (DREZC) for Interventional Pain Management: A Systematic Review. Pain Ther 2022;11:411-445.
  • Park SW, Shin YS, Kim HJ, Lee JH, Shin JS, Ha IH. The dischargeable cut-off score of Oswestry Disability Index (ODI) in the inpatient care for low back pain with disability. Eur Spine J 2014;23:2090-2096.
  • McKay SM, McLachlan EM. Inflammation of rat dorsal root ganglia below a mid-thoracic spinal transection. Neuroreport 2004;15:1783-1786.
  • Nagda JV, Davis CW, Bajwa ZH, Simopoulos TT. Retrospective review of the efficacy and safety of repeated pulsed and continuous radiofrequency lesioning of the dorsal root ganglion/ segmental nerve for lumbar radicular pain. Pain Physician 2011;14:371-376.
  • Erdine S, Yucel A, Cimen A, Aydin S, Sav A, Bilir A. Effects of pulsed versus conventional radiofrequency current on rabbit dorsal root ganglion morphology. Eur J Pain 2005;9:251-256.
  • Tun K, Cemil B, Gurcay AG, et al. Ultrastructural evaluation of Pulsed Radiofrequency and Conventional Radiofrequency lesions in rat sciatic nerve. Surg Neurol 2009;72:496-500.
  • Abejón D, Garcia-del-Valle S, Fuentes ML, Gómez-Arnau JI, Reig E, van Zundert J. Pulsed radiofrequency in lumbar radicular pain: clinical effects in various etiological groups. Pain Pract 2007;7:21-26.
  • Türkyılmaz GG. Factors associated with treatment success after combined transforaminal epidural steroid injection and dorsal root ganglion pulsed radiofrequency treatment in patients with chronic lumbar radicular pain. Turk J Med Sci 2022;52:1241-1248.
  • Vigneri S, Sindaco G. Efficacy of High-Voltage Pulsed Radiofrequency in Chronic Lumbosacral Radicular Pain: An Improved Tool? Neuromodulation 2024;27:217.
  • Van Boxem K, de Meij N, Patijn J, et al. Predictive Factors for Successful Outcome of Pulsed Radiofrequency Treatment in Patients with Intractable Lumbosacral Radicular Pain. Pain Med 2016;17:1233-1240.
  • Kim SJ, Park SJ, Yoon DM, Yoon KB, Kim SH. Predictors of the analgesic efficacy of pulsed radiofrequency treatment in patients with chronic lumbosacral radicular pain: a retrospective observational study. J Pain Res 2018;11:1223-1230.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Anesteziyoloji
Bölüm Araştırma Makaleleri
Yazarlar

Gökhan Yıldız 0000-0001-5905-938X

Ezgi Can 0000-0002-9902-3485

Yayımlanma Tarihi 14 Ekim 2024
Gönderilme Tarihi 28 Mayıs 2024
Kabul Tarihi 16 Temmuz 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 6 Sayı: 3

Kaynak Göster

AMA Yıldız G, Can E. Comparison of the Efficacy of Dorsal Root Ganglion Pulsed Radiofrequency for 2 Minutes versus 4 Minutes in the Treatment of Chronic Lumbosacral Radicular Pain. Hitit Medical Journal. Ekim 2024;6(3):313-320. doi:10.52827/hititmedj.1491642