Pulsed Radiofrequency Provides Durable Back Pain Relief

By Alex Morrisson

DG News

Computed tomography (CT)-guided pulsed radiofrequency is superior to injection only for patients with back pain caused by nerve pressure, researchers reported here at the 2018 Annual Meeting of the Radiological Society of North America (RSNA).

One year after undergoing the treatment 95% of the 113 patients in the studied reported they had achieved relief of leg pain compared with 61% of 116 patients who had injections only (P< .001).

“With just a single injection using pulsed radiofrequency, the pain scores went down and quality of life scores improved,” reported Alessandro Napoli, MD, Sapienza University of Rome, Rome, Italy.

“Spine interventions are very common in our community because technology now allows us to use probes very close to the neuro-structure instead of going directly into the disc hernia,” he explained. “With our new technology, our probe is so tiny that you do not need anaesthesia. You can insert the needle through real-time image guidance that gives us a resolution of 0.5 mm. We use the precision of the CT-scan to get as close as we can to the nerve root.”

“We give the probe 10 minutes of this very gentle pulse and the patient may feel nothing,” said Dr. Napoli. “After the 10 minutes of pulsed radiation, we take advantage of the position of the needle and introduce a small amount of steroid.”

He acknowledged that there is a question of whether the effect seen is due to the pulsed radiofrequency or the steroid injection, so he conducted the study to compare the modalities, and the combination was a clear winner.

“More than 90% of pour patients indicated they had received clinical benefit from the combination, and 80% of these patients were pain-free after 1 year,” said Dr. Napoli. “In the steroid injection only group, 65% reported clinical benefit after 1 year and 55% were free from pain.”

The benefit was significantly better with pulsed radiofrequency at 4 weeks, 12 weeks, and at 52 weeks, compared with steroid injection alone.

[Presentation title: CT-Guided Pulsed Radiofrequency in Patients With Acute Low Back Pain and Sciatica: 1-Year Follow-Up Versus Image-Guided Injection Only as Control Group. Abstract SSJ26-01]