1、Percutaneous Pulsed Radiofrequency in the Treatment of Cervical and Lumbar Radicular Pain Experiences of 154 Patients經皮脈衝高頻療法治療頸腰椎神經根疼痛一百五十四個病人的經驗 趙紹清醫師,鄒錫凱醫師,沈炯祺主任 台中榮民總醫院神經外科 Introduction of Pulsed RFnPrecise anatomic locations nBrief“pulses”of high-voltage,radiofrequency range electrical current
2、nNot to produce a heat lesion above 45CnProduce analgesia without producing destruction of nervesnPain relief caused by cellular changes induced by magnetic fields,not tissue destruction by heatnNeuromodulation,not neuroablationnSuccess in reducing a number of different chronic pain states in past t
3、en yearsLumbar HIVD with radiculopathy6 months(N=108)6%)patients,the procedure was successful(pain reduction more than 50%)and lasted on average 3.81%)after cervical and lumbar pulse radiofrequency stimulation had pain relief 50%at the follow-up period of six months.3 months(N=116)This paper reports
4、 the results of a clinical audit of the first consecutive 18 patients with intractable cervicobrachialgia and who were treated with PRF of the cervical dorsal root ganglion.Sluijter ME.*The improvement was defined as patient who has the pain relief 0;The satisfaction was defined as patient who has t
5、he pain relief 50%Cohen SP,Foster A.Significant reduction was found in the Visual Analog Scale for pain from an average of 8.趙紹清醫師,鄒錫凱醫師,沈炯祺主任Introduction of Pulsed RFDisc An Initial Report,Pain Practice,Volume 5,Issue 2,2005 111115The role of radiofrequency in failed back surgery patients.Previous
6、failed cervical surgery1 year(N=7)Shah RV,Racz GB.14%)and 10 in 43 numbers(23.Reports on MidlinenMunglani R.The longer term effect of pulsed radiofrequency for neuropathic pain.Pain 1999;80:4379.nVan Zundert J,Brabant S,Van de Kelft E,Vercruyssen A,Van Buyten JP.Pulsed radiofrequency treatment of th
7、e Gasserian ganglion in patients with idiopathic trigeminal neuralgia.Pain 2003;104(3):44952.nVan Zundert J.,Percutaneous Pulsed Radiofrequency Treatment of the Cervical Dorsal Root Ganglion in the Treatment of Chronic Cervical Pain Syndromes:A Clinical Audit,Neuromodulation,Volume 6,Number 1,2003 6
8、14nGeurts JW,van Wijk RM,Wynne HJ,Hammink E,Buskens E,Lousberg R,et al.Radiofrequency lesioning of dorsal root ganglia for chronic lumbosacral radicular pain:a randomised,doubleblind,controlled trial.Lancet 2003;361(9351):216.nMikeladze G,Espinal R,Finnegan R,Routon J,Martin D:Pulsed radiofrequency
9、application in treatment of chronic zygapophyseal joint pain.Spine J 2003;3:3602nCohen SP,Foster A.Pulsed radiofrequency as a treatment for groin pain and orchialgia.Urology 2003;61:45.nSluijter ME.The role of radiofrequency in failed back surgery patients.Curr Rev Pain 2000;4:4953.nShah RV,Racz GB.
10、Long-term relief of posttraumatic headache by sphenopalatine ganglion pulsed radiofrequency lesioning:a case report.Arch Phys Med Rehabil 2004;85(6):10136.nTeixeira A,Grandinson M,Sluijter ME.Pulsed Radiofrequency for Radicular Pain Due to a Herniated Intervertebral DiscAn Initial Report,Pain Practi
11、ce,Volume 5,Issue 2,2005 111115 Reports on MidlinenThis is a retrospective analysis on 114 Patients with a chief complaint of axial cervical or lumbar pain and who denied radicular symptoms were treated with PRF.In 68(68/114,59.6%)patients,the procedure was successful(pain reduction more than 50%)an
12、d lasted on average 3.93 1.86 months.Mikeladze G,Espinal R,Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain.Spine J 2003;3:3602nThis paper reports the results of a clinical audit of the first consecutive 18 patients with intractable cervicobrachialgia and who were t
13、reated with PRF of the cervical dorsal root ganglion.Satisfactory pain relief of at least 50%was achieved in 13 of 18(72%)patients at post-operation 8 weeks.More than one year after treatment,6 patients(33%)continue to rate treatment outcome as good or very good.Van Zundert J.,Percutaneous Pulsed Ra
14、diofrequency Treatment of the Cervical Dorsal Root Ganglion in the Treatment of Chronic Cervical Pain Syndromes:A Clinical Audit,Neuromodulation,Volume 6,Number 1,2003 614Produce analgesia without producing destruction of nervesVisual analog pain scaleLumbar HIVD with radiculopathyArch Phys Med Reha
15、bil 2004;85(6):10136.The role of radiofrequency in failed back surgery patients.The role of radiofrequency in failed back surgery patients.Radiofrequency lesioning of dorsal root ganglia for chronic lumbosacral radicular pain:a randomised,doubleblind,controlled trial.9 months(N=21)(L5)112Visual anal
16、og pain scaleSpine J 2003;3:3602Reports on MidlinenThis is a retrospective study on 13 consecutive patients with radicular pain,due to a herniated intervertebral disc,at levels L3 to S1.All were treated with PRF of lumbar dorsal root ganglion.The numeric rating scale(NRS)score fell from 7.83 to 2.25
17、 over the first 2 weeks.Teixeira A,Pulsed Radiofrequency for Radicular Pain Due to a Herniated Intervertebral Disc An Initial Report,Pain Practice,Volume 5,Issue 2,2005 111115nThis study reports the result of pulsed RF in 28 patients suffering from severe radicular pain treated by pulsed RF.There we
18、re 20 cases of low back pain and 8 with neck pain.The first follow-up after 3 months revealed the following results:excellent results in 2 cases(7.1%),good results in 12 cases(42.9%),fair in 9(32.1%)and unresponsiveness to treatment in 5(17.9%).Significant reduction was found in the Visual Analog Sc
19、ale for pain from an average of 8.8 to 4.2 after 3 months,4.8 after 6 months and 4.9 after 1 year.Pevzner E;David R;Leitner Y,Pulsed radiofrequency treatment of severe radicular pain,Harefuah,2005 Mar;Vol.144(3),pp.178-80,231.Patient selectionnWe collected 154 cases with a chief complaint of cervica
20、l or lumbar radicular pain due to a herniated intervertebral disc or previous failed surgery,from September 2004 to October 2005 nFollow-up period was from one week to one year postoperatively.nThere are 71 male and 83 female patients.nThe mean preoperative visual analog pain scale of patients who h
21、ad cervical,lumbar radicular pain were 67.5514.37,65.5216.44(0-100).Table 1.The demographic and clinical features of 154 patients Cervical(N=49)Lumbar(N=116)Total(N=165)Male range17 32-7658 26-9275Female range32 39-7958 31-8890Age(years,mean SD)53.20 10.9962.42 13.16 Visual analog pain scale(0-100,m
22、ean SD)67.55 14.3765.52 16.44 Cervical(n=49)Lumbar(n=116)Nerve roots(C3)3(L3)18 (C4)40(L4)95 (C5)49 (L5)112 (C6)30(S1)19(C7)2 Disease classification Cervical HIVD with radiculopathy44 Previous failed cervical surgery5 Lumbar HIVD with radiculopathy 88 Failed back surgery syndrome 28Treatment side Rt
23、.2966 Lt.2050Table 2.The treatment levels and disease classification *The improvement was defined as patient who has the pain relief 0;The satisfaction was defined as patient who has the pain relief 50%1 week(N=49)1 month(N=49)3 months(N=49)6 months(N=40)9 months(N=21)1 year(N=7)worse0000000%1010141
24、5730&50%139832050=&0;The satisfaction was defined as patient who has the pain relief 50%1 week(N=116)1 month(N=116)3 months(N=116)6 months(N=108)9 months(N=58)1 year(N=43)worse0000000%2126344828200&50%36343017141350=&10051443932117100%812131153Improvement rate(%)*81.90 77.59 70.69 55.56 51.72 53.49
25、Satisfactory rate(%)*50.86 48.28 44.83 39.81 27.59 23.26 Table 4.Results after lumbar pulsed radiofrequency stimulation 0%20%40%60%80%100%1 week(N=116)1 m ont h(N=116)3 m ont hs(N=116)6 m ont hs(N=108)9 m ont hs(N=58)1 year(N=43)Aft er Lum bar Pul sed Radi ofrequencySym pt om FreeBet t erSl i ght l
26、y Bet t erUnchangedAggravat edFigure 3.0.0010.0020.0030.0040.0050.0060.0070.00Bef or e RF1 week 1 m ont h3 m ont hs6 m ont hs9 m ont hs1 year Aft er Lum bar Pul sed Radi ofrequencyPai n Scal eFigure 4.Visual analog pain scale distribution on lumbar patients with improvement 50%and last for more than
27、 1 monthResultsn30 in 49 numbers(61.22%)and 56 in 116 numbers(48.28%)after cervical,and lumbar pulse radiofrequency stimulation had the initial improvement 50%in the first month follow up.n22 in 40 numbers(55.00%)and 43 in 108 numbers(39.81%)after cervical and lumbar pulse radiofrequency stimulation
28、 had pain relief 50%at the follow-up period of six months.nAfter one year follow up,4 in 7 numbers(57.14%)and 10 in 43 numbers(23.26%)after cervical and lumbar pulse radiofrequency stimulation had the pain relief effect 50%.ConclusionnThe results of this retrospective analysis showed that the application of pulsed radiofrequency is a safe and useful intervention for cervical and lumbar radicular pain(approximately one year).nAlthough pulsed radiofrequency appears to provide intermediate-term relief of pain,further studies with long-term follow-up are necessary.Thank you for your attention
