A minimally invasive procedure in which pulses of energy from a probe are applied directly to nerve roots near the spine is safe and effective in people with acute lower back pain that has not responded to conservative treatment, according to a study being presented at the 2018 Annual Meeting of the Radiological Society of North America (RSNA).
Computed tomography (CT)-guided pulsed radiofrequency (pRF), applies energy through an electrode under CT guidance to the portion of the nerve responsible for sending pain signals.
“Pulsed radiofrequency creates a nerve modulation, significantly reducing inflammation and its associated symptoms,” said senior author Alessandro Napoli, MD, Sapienza University of Rome, Rome, Italy.
The researchers studied the approach in patients with back pain from lumbar disk herniation that had not responded to prolonged conservative treatment. In 128 patients, the pRF treatment was delivered directly under CT guidance to the root of the nerve. The treatment was applied for 10 minutes. For comparison, a group of 120 patients received 1 to 3 sessions of CT-guided steroid injection on the same anatomical target with no pRF.
The 1-year outcomes demonstrated that CT-guided pRF was superior to the injection-only strategy. Patients who received pRF saw greater overall improvement in pain and disability scores during the first year. Relief of leg pain was faster in patients assigned to pRF, and they also reported a faster rate of perceived recovery.
The probability of perceived recovery after 1 year of follow-up was 95% in the pRF group compared with 61% in the injection only group.
“Given our study results, we offer pulsed radiofrequency to patients with herniated disk and sciatic nerve compression whose symptoms do not benefit from conservative therapy,” said Dr. Napoli.
“Of the different therapies available, pulsed radiofrequency is among the least invasive,” he added. “Treatment lasts 10 minutes, and one session was enough in a large number of treated patients.”
Dr. Napoli noted that the results of the study are superior to those typically reported for usual care strategies and injections and may help a substantial number of patients with sciatic disk compression to avoid surgery.
The use of pRF also could improve outcomes for patients set to receive corticosteroid injections.
“We learned that when pulsed radiofrequency is followed by steroid injection, the result is longer lasting and more efficacious than injection only,” said Dr. Napoli. “The effect of pulsed radiofrequency is fast and without adverse events.”