BACKGROUND: Lumbosacral radicular pain (LRP) results from the ectopic activation of nociceptive afferent fibers in a spinal nerve or its roots. Lumbar disc prolapse is the most prevalent cause of LRP. This condition significantly impacts patients' quality of life and is deemed a burden on communities and health care facilities alike. The utilization of pulsed radiofrequency (PRF) in dorsal root ganglion stimulation (DRG-S) has demonstrated efficacy with a wide applicability across various conditions. However, whether elevating the voltage of PRF to between 55-75 volts could augment its clinical efficacy remains uncertain.
OBJECTIVES: The primary measure of outcome was the Numeric Rating Scale (NRS) score between the 2 groups . The secondary outcomes included functional outcomes as evaluated on the Oswestry Low Back Disability Questionnaire and intra- or post-intervention complications.
STUDY DESIGN: A prospective, double-blinded, randomized controlled study.
SETTING: The study was carried out at the Medical Research Institute of Alexandria University.
METHODS: The study included 96 patients with lumbosacral radicular pain caused by disc prolapse. They were randomly divided into 2 equal groups to receive high-voltage pulsed radiofrequency (HV-PRF) (Group I) or standard-voltage PRF (Group II) adjacent to the DRG corresponding to the affected dermatome. Scores on the NRS and Oswestry Low Back Disability Questionnaire were evaluated at one week and one, 2, 3, and 6 months after the intervention. The complications of the intervention were recorded.
RESULTS: In both groups, NRS scores decreased significantly from the pre-intervention ratings at all post-intervention studied times (P = 0.001). However, this decline was significantly more observable in Group I than in Group II (P = 0.001). The percentage of patients reporting NRS reductions = 50.0% was significantly higher in Group I than Group II at one, 2, 3, and 6 months after the intervention (P = 0.001). Similarly, when compared to the pre-intervention ratings, Oswestry Low Back Disability scores decreased significantly in both groups at all studied post-intervention times (P = 0.001), but this reduction was significantly greater in Group I than in Group II (P = 0.001). The percentage of patients who reported Oswestry Low Back Disability score reductions = 50.0% was also significantly higher in Group I (37.5%, 66.7%, 75% and 81.3% of patients at one, 2, 3, and 6 months, respectively, post-intervention) than in Group II (no patients at one and 2 months, 8.3% and 14.6% at 3 and 6 months, respectively, post-intervention) (P = 0.001). No major complications were recorded for either of the studied groups.
LIMITATIONS: Short study period, single-centre study.
CONCLUSIONS: High- and standard-voltage PRF administered in an area adjacent to the dorsal root ganglion provides significant improvements in radicular pain, as measured by the NRS, and function capacity, as measured by the Oswestry Disability Index, in patients with LRP associated with disc prolapse. However, of the 2 types of PRF procedures, HV-PRF yields superior pain relief and augments patients' functional status to a greater degree.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
Both treatments significantly reduced pain and disability, with HV-PRF consistently outperforming the other over 6 months. Adjusting the voltage escalation to individual tolerance appears to improve neuromodulatory effectiveness. Nonetheless, the results are limited in generalizability due to the single-centre design and the short follow-up period.
Physician rater
HV-PRF is a promising non-neurodestructive option in the conservative-to-surgical gap, potentially delaying or avoiding surgery. However, optimal dosing remains unresolved. The single-centre, 6-month design limits generalizability, so multicentre trials with longer follow-up and current-based protocols are needed before routine adoption.
, McMaster University