Clinics in Surgery Chronic Lumbosacral Painful Unilateral Radiculopathy: Dorsal Root Ganglion Pulsed Radiofrequency vs. Transforaminal Epidural Steroid Injection: A Prospective Randomized Study OPEN ACCESS

Abstract

Background: Pulsed Radiofrequency (PRF) procedures are a minimally invasive and target-selective modality procedure. PRF procedure becoming an increasingly used treatment for chronic radicular pain and competitive with Transforaminal Epidural Steroid Injection (TFESI).

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Clinics in Surgery
2020 | Volume 5 | Article 2759
1
Chronic Lumbosacral Painful Unilateral Radiculopathy:
Dorsal Root Ganglion Pulsed Radiofrequency vs.
Transforaminal Epidural Steroid Injection: A Prospective
Randomized Study
OPEN ACCESS
*Correspondence:
Mihails Arons, Department of
Anesthesiology and Intensive Care,
Riga Stradins University, Riga, Latvia,
E-mail: dr.mihailsarons@gmail.com
Received Date: 03 Feb 2020
Accepted Date: 04 Mar 2020
Published Date: 10 Mar 2020
Citation:
Arons M, Strīķe E, Pilmane M,
Vasiļevskis E, Evansa I, Paņihins I,
et al. Chronic Lumbosacral Painful
Unilateral Radiculopathy: Dorsal Root
Ganglion Pulsed Radiofrequency
vs. Transforaminal Epidural Steroid
Injection: A Prospective Randomized
Study. Clin Surg. 2020; 5: 2759.
Copyright © 2020 Mihails Arons. This
is an open access article distributed
under the Creative Commons
Attribution License, which permits
unrestricted use, distribution, and
reproduction in any medium, provided
the original work is properly cited.
Research Article
Published: 10 Mar, 2020
Abstract
Background: Pulsed Radiofrequency (PRF) procedures are a minimally invasive and target-selective
modality procedure. PRF procedure becoming an increasingly used treatment for chronic radicular
pain and competitive with Transforaminal Epidural Steroid Injection (TFESI).
Methods: A prospective randomized, blind study was performed to evaluate the therapeutic eect
of lumbar Dorsal Root Ganglion (DRG) PRF treatment and lumbar TFESI and to compare ecacy
of these two techniques, on the patient with chronic unilateral lumbosacral radicular pain with
radiculopathy. e study included a total of 72 patients, of whom 35 were randomized to PRF group,
35 patients - to TFESI group, and 2 patients received placebo. e outcome of the treatment either
by PRF or TFESI was evaluated by Global Perceiving Eect (GPE) and decrease in NRS and ODQ
at day 30, 60 and 180. Aer 30th day follow-up, patients with GPE Likert scores ≤ 5 had received the
second, identical procedure.
Results: GPE increased with time for both PRF and TFESI groups, reached at day 180 follow-up
6.2 for PRF and 6.3 for TFESI. Statistical comparison of improvements, caused by PRF and TFESI
does not revealed signicant dierence in the treatment outcomes, i.e. generally values of GPE,
decrease of NRS and decrease of ODQ was similar for PRF and TFESI treatments during entire
follow up period. e only exception was decrease in ODQ scale at the day 30 that was higher for
PRF treatment (P-value 0.02).
Alongside, in PRF group there was only 9% of patients with less than 20% improvement in disability,
as compared with 29% in TFESI group. But at the day 180, the proportion of patient with pain
reduction more than 60% in TFESI group exceeded one for PRF group.
Conclusion: e eectiveness of DRG PRF and TFESI by evaluation of three assessment’s tools:
GPE, NRS and ODQ demonstrates the eciency of the PRF in short-term response (30 days follow-
up) due to the notably higher decrease in ODQ scores in PRF than into the TFESI group, despite
of similar GPE and NRS scores in both groups. TFESI procedure is more eective in long-term
perspective, proved by slightly higher proportion of patients with pain reduction.
Keywords: Pulsed radiofrequency; Chronic lumbosacral radiculopathy; Dorsal root ganglion;
Epidural steroid injection
Mihails Arons1*, Eva Strīķe2, Māra Pilmane3, Edgars Vasiļevskis3, Irina Evansa1, Igors Paņihins2
and Jekaterina Logasina4
1Department of Anesthesiology and Intensive Care, Riga Stradins University, Riga, Latvia
2Department of Anesthesiology and Intensive Care, Pauls Stradins Clinical University Hospital, Riga, Latvia
1Department of Morphology, Riga Stradins University, Institute of Anatomy and Anthropology, Riga, Latvia
4Department of Anesthesiology, Riga Eastern Clinical University Hospital, Intensive Care Unit, Riga, Latvia
Background
Pulsed Radiofrequency (PRF) is neural tissue preserving alternative to spinal nerve ablation
procedure, previously used to treat chronic pain conditions characterized by resistance and/
or increasing tolerance to opioid analgesics and epidural steroid injections [1,2]. Chronic pain
localization, ranged from most to least frequent, is lower and upper back is approximately 24%
according to patient self-assessment [3-6].

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Standardized PRF procedure has demonstrated clinical
eectiveness, signicantly reducing pain of dierent etiology and
localization, such as herniated disk/failed back surgery syndrome
induced low back and leg pain, chronic lumbar radicular pain and
this type of pain with neuropathic futures etc. [7-11].
In approximately 45% of the cases of low back pain has originates
from the degenerative intervertebral disc. PRF treatment in the
nucleus would change the conductivity of nerve endings that have
been sprouting into the nucleus because of disc degeneration. e
application of the electric eld of PRF in the disc may also induce
healing processes involving the activation of the immune system, thus
reducing the inammation process of chronic pain. e eectiveness
of PRF applied to the Dorsal Rot Ganglion (DRG) has been employed
for pain relief in patients with cervicobrachial pain, thoracic
radiculopathy, and chronic lumbar radicular pain [7,12,13].
Transforaminal Epidural Steroid Injection (TFESI) is a classical,
minimally invasive treatment for radicular pain with a denite short-
term ecacy. Injections are widely adopted to alleviate and control
radicular pain in accord with current guidelines. e relief of pain
or functional recovery outcome is higher at 2 weeks than 2 months.
Although the ecacy term is controversial due to drug metabolism
[14]. Repeated steroid injections may have adverse eects [15,16].
Objectives
is study was performed to compare the eectiveness of Pulsed
Radiofrequency (PRF) administered to a targeted Dorsal Root
Ganglion (DRG) and TFESI for the treatment of radicular pain and
radiculopathy.
Methods
Target population: Patients aged 18 to 65 years who suer from
chronic unilateral lumbosacral radicular pain with radiculopathy
(Numeric Analog (Rating) Scale (NRS) >5) with no signicant motor
decit (muscle strength >3, Medical Research Council (MRC) Scale
for Muscle Strength) and who does not respond to conservative
therapy. e diagnosis of Chronic Lumbosacral Radicular Pain
with radiculopathy (CLRP) was based on a medical history, clinical
examination and Standardized Evaluation of Pain (StEP scale).
Patient selection also was based on Computer Tomography (CT)
or Magnetic Resonance Imaging (MRI) ndings within the last 6
months. e results of the radiological study had to be consistent with
the clinical symptoms.
For each patient participating this study, inclusions criteria, the
nature and importance of the study and the course of all invasive
procedures, with possible complications and side eects were
explained. e study included a total of 72 patients, of whom 35 were
randomized to PRF group, 35 patients- to TFESI group, and 2 patients
received placebo. Considering the multisegmental innervation
of the aected area, each procedure is performed at 1 or 2 levels,
depending on anatomical changes and dermatomal irradiation. Prior
the procedures, the patients were requested to estimate their pain
level by Numeric Analog Scale (NRS) and ll the Oswestry Low Back
Pain Disability Questionnaire (ODQ).
Patients, randomized to PRF group received DRG PRF
stimulation procedure on the one or two level/s, depending on
dermatomal contribution of pain, using Neurotherm (NT) 1100
generator, 10 or 15 cm, 20-gauge Radiofrequency (RF) needle with
5 mm active tip, under X-ray control. PRF procedure is performed
with the following parameters: 42 volt, 7 min, 5 pulses per min, 5
millisecond one pulse length. Correct needle position was validated
by sensor and motor neurostimulation. RF needle was considered as
properly positioned, when sensor stimulation was positive at voltages
till to 0.5 V, but motor stimulation- at voltages till to 1 V (or doubled
sensor stimulation). During the PRF procedure, the device volume
was muted to prevent the patient from recognizing which of the 3
procedures he is undergoing.
Patients, randomized to TFESI group received TFESI with
Triamcinolone 40 mg - 1 ml, Bupivacaine 0.5% - 1 ml and saline
0.9% - 1 ml. e dose of Triamcinolone was total 40 mg/3 ml per
procedure. If patients received TFESI on two levels volume of each
injection was 1.5 ml. e injection was performed at the levels of
intervertebral disc herniation's using standard technique, 10 cm or
15 cm, 20G Tuohy needle, under X-ray control and contrast uid, in
order to see medications spreading in to the anterior epidural space.
During the placebo procedure, puncture, sensory and motor
stimulation were performed without actual application of PRF or
drug administration. Aer any procedure, each patient was observed
before discharge from 30 min up to 1 h. Skin anesthesia was performed
with Lidocaine 2% - 1 ml.
During follow-up, the Globally Perceived Eect (GPE) of the
treatment was evaluated using 7 level Likert scale. Patient’s pain level
and general disability were evaluated using NRS and ODQ scores.
e follow-up sessions were assigned at 30+2, 60 ± 2 and 180 ± 2 day
aer procedure. All patients were evaluated by a pain specialist who
had not performed the procedures and did not know what procedure
had been completed previously. If at the day 30 of follow-up the GPE
of a patient was less than 50% from the baseline (5 and less by Likert
scale), the patient received second procedure, identical to the rst
one.
Exclusion Criteria was: Strong or progressive motor decit
(muscle strength <3 according to Medical Research Council (London,
1976)), patients with coagulation disorders, spinal canal stenosis with
intermittent claudication, severe psychopathy or psychiatric illness
in patients history, allergies to local anesthetics or contrast agents,
chronic heart failure III-IV aer NYHA, chronic renal disease with
glomerular ltration rate less than 30 ml/min, chronic liver failure
(stages II-III), pregnancy, malignant or benign spinal tumor or
metastases, infection and previous spine surgery in patients history.
Observations, obtained for PRF and TFESI groups were
compared, mainly using Student t-test for age and ODQ scores data
and non-parametric Mann-Whitney rank test for GPE and NRS data.
Signicance level α=0.05 was applied through the whole study.
At the 30 day of follow-up, both placebo patients demonstrated
GPE less than 25% and were excluded from further study due to
ethical reasons in according with initial research design.
Results
e experimental pool included 38 females and 32 males, their
average age, initial pain level (NRS scores) and disability level (ODQ
scores) are summarized in the (Table 1). Statistical comparison of
male and female patients using Student test for age (P=0.33) and
ODQ scores (P=0.31), and Mann-Whitney test for NRS scores
(P=0.79) did not indicated any dierence between male and female
groups. erefore, no stratication by patient sex was applied.
In turn, characterizes randomized experimental PRF and

Mihails Arons, et al., Clinics in Surgery - General Surgery
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TFESI groups' prior procedure (Table 2). ere was no dierence
in average age and ODQ scores between groups (Student test,
P=0.95 and P=0.22, correspondingly), but NRS scores were higher
for TFESI group (8.0 for TFESI against 7.2 for PRF, Mann-Whitney
test P=0.00026). To avoid possible inuence of between-group’s
dierence, the improvement in both patient’s pain and disability
levels was evaluated as changes (decrease) in NRS and ODQ scores
in respect to prior procedure values. e GPE, expressed using Likert
scale, was evaluated in absolute values.
Aer 30th day follow-up, 17 patients (49%) in PRF group and 20
patients (57%) in TFESI group had GPE less than 50% (Likert scores
≤ 5) and had received the second, identical procedure. e dierence
was evaluated using Z-test for proportions, resulting P-value (P=0.47)
suggests that there is no dierence between groups in number of
patients, having insucient result aer the rst procedure. Hereby,
using data for both groups, one could estimate that about 53% of
patients would require second procedure.
During entire follow up period, 2 patients (6%) in PRF group and
7 patients (20%) in TFESI group started use of additional medication.
Although number of such patients in TFESI group wars more than
three times higher, this dierence could be explained merely by
chance (Exact Fisher test, P=0.12).
Table 3 -results of patient follow-up in both experimental groups
at 30, 60 and 180 days aer procedure. e outcome of the treatment
was evaluated for each group as average GPE scores, average decrease
of NRS scores and average decrease of ODQ scores. Groups were
compared using Mann-Whitney test for GPE and NRS and Student
test for ODQ values, the corresponding P-values are presented in the
Table 3, too.
Improvement, observed for both treatments demonstrated
tendency to grow with time: average GPE increased from 5.5 at day
30 to 6.2 at day 180 for PRF and from 5.1 to 6.3 for TFESI (Figure 1a).
Similarly, reduction in pain level and disability was observed. Average
decrease of NRS scores gradually changed from 3.3 at day 30 to 4.5 at
day 180 for PRF and from 2.9 to 5.5 for TFESI. is corresponds to
the lowering of the initial NRS score and patient pain level by 46% to
62% for PRF and to 37% to 69% for TFSI (Figure 1b). Disability level
scores decreased by 10.8 at the day 30, reduction reached 17.1 at the
day 180 for PRF, gures for TFESI was 8.2 and 19.4. is decrement
corresponds to lowering of the patients’ disability (as measured by
ODQ scores) by 41% to 64% for PRF and 29% to 69% for TFESI
(Figure 1c). From the other hand, statistical comparison of the PRF
and TFESI does not revealed signicant dierence in the treatment
outcomes, i.e. generally values of GPE, decrease of NRS and decrease
of ODQ was similar for both treatments at any follow-up day. e
only exception is the values of ODQ decrease at the day 30, which
is higher for PRF treatment, the corresponding P-value generated
by Student test 0.02. Still, comparison of three parameters at three
follow-up sessions required nine simultaneous tests at signicance
level 0.05, that gives nearly 36% probability to get at least one false-
positive test result with P<α even for actually identical groups. In
other words, present research results do not provide any reasons to
claim either method to be more eective.
Summarizes results of improvement analysis for individual
patients, indicating number of patients, that reported certain level
of improvement during follow-up visit, alongside the data are
visualized at (Figure 2 and 3) (Table 4). e ndings are in line with
Patient
number Age,
full years Pain level,
NRS scores Disability level,
ODQ scores
Females 38 50 ± 9 7.6 ± 1.0 28 ± 5
Males 32 52 ± 8 7.7 ± 0.9 27 ± 4
Total 70 51 ± 9 7.6 ± 1.0 27 ± 4
Tables 1: Characterization of the patient pool prior treatment.
Patient
number Age,
full years Pain level,
NRS scores Disability level,
ODQ scores
PRF group 35 51 ± 9 7.2 ± 0.8 27 ± 4
TFESI group 35 51 ± 8 8.0 ± 1.0 28 ± 4
Total 70 51 ± 9 7.6 ± 1.0 27 ± 4
Tables 2: Characterization of the experimental group’s prior treatment.
a.
.
b. c.
Figure 1: Changes in average indicators - GPE (a), measured by Likert
scale, reduction in pain level, measured by NRS scores and reduction in
disability, measured by ODQ scores - for patient groups, treated with PRF
(b) and TFESI (c).
a. b.
Figure 2: Distribution of the pain level improvement, measured by changes
in NRS scores during follow-up in patients treated with PRF (a) and TFESI
(b).
a. b.
Figure 3: Distribution of the disability level improvement, measured by
changes in ODQ scores during follow-up in patients treated with PRF and
(a) TFESI (b).

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4
observations, made for average improvement values.
At the day 30, patients, treated with RPF demonstrated better
outcomes: 35% of patients had more than 60% improvement in pain
level, to be compared with 3% for TFESI treatment; in addition,
there were no patient with improvement over 80% in TFESI group.
Proportion of patient with less than 20% improvement in disability
was 9% for PRF and 29% for TFESI. At the day 60, outcomes of
both methods become closer: e pain level reduction over 60% was
observed in 45% of patients, treated with PRF and in 30% of patients
with TFESI, the proportion of patient with low improvement in
disability aer TFESI decreased nearly twice-up to 15%.
Finally, at the day 180, the proportion of patient with pain
reduction more than 60% in TFESI group exceeded one for PRF
group (67% vs. 60%). ere were no patients in TFESI group with
improvement less than 40% both for NRS and ODQ scores, while in
the PRF group there were 15% of patients with less than 40% reduction
in NRS scores and 16% of patients with less than 40% reduction in
ODQ scores. ere were no adverse eects observed aer treatment
with any modality.
Discussion
In this study, both the short and long-term eects of DRG PRF and
TFESI to treat unilateral chronic lumbosacral painful radiculopathy
were evaluated and the results were compared.
From previous research it is known that radiofrequency methods
have been used over the last 30 years to treat pain syndromes caused
by various pathologies, including back pain due to facet joint
dysfunction, radicular pain, discogenic and sacroiliac joint pain,
cervicogenic headache, medulla spinalis injuries, and intercostal
neuralgia [1].
Our results showed that all indicators, - GPE, NRS and ODQ
measured by us demonstrates similar tendency: e improvement
and decrease of pains which is better at day 30 for the PRF treatment,
but at the long time scale (day 180) the outcome of TFESI treatment
exceeds one for PRF. is could suggest that PRF treatment provides
better improvement in short term, while TFESI procedure is more
eective in long-term perspective. Also, other scientists tried to
compare the above-mentioned methods.
So, Lee et al. [15] in a prospective randomized trial also compared
the eectiveness of PRF and TFESI for the treatment of radicular pain
for forty-four patients with disc herniation's in the neck and lumbar
part of the spine for a two year-long period. Trial patients’ age varied
with a range of 20-70 years and 38 patients were divided into two
groups: PRF (n=19) and TFESI (n=19). Aer the procedure, patients
were examined in 2, 7, 8 and 12 months, which was comparatively
close to our examination time. Similar to our study, ODQ index was
analyzed; however, our study diered with additionally detected NRS.
e results showed no statistically signicant dierence between the
PRF and TFESI groups. us, we suppose that probably even despite
the dierent pathogenetic mechanisms in suppression of pain, the
nal result is similar in successful cases of treatment with both, -
PRF and TFESI. is is our suggestion is directly supported by those
scientists who have combined therapies of pains.
So, in search for depression in lumbar radicular pain Koh at al.
[17] in a randomized, double-blinded, active-comparator controlled
study determined the eects of combining PRF treatment and TFESI
to treat sixty-two patients with chronic LRP caused by lumbar spinal
stenosis. e PRF group received 3 cycles of PRF treatment, aer a
local anesthetic with the steroid was injected. e trial patients were
divided into two groups (PRF group =31; control group =31). e
study’s outcome describes the use of the NRS, ODQ and GPE scale, as
our trial does. e age of the patients included in the study was similar
to ours >20 years. Pain intensity >4 on NRS like including criteria
was the same. e results showed that the number of patients with
successful treatment was higher in the PRF group. e conclusion
was that PRF could be combined with TFESI to achieve best treatment
eect compared to TFESI alone. is combination would increase the
treatment response to the TFESI. Authors didn’t observe signicant
dierences in terms of the mean NRS, ODQ between the PRF and
control groups. No serious adverse events and other complications
were noted [17].
We agree that probably only one trial can’t be the basis for this
treatment combination to be recommended as a rst-line treatment
for patients with LRP with radiculopathy and as this trial’s LRP caused
GPE, average Likert scores PRF TFESI
P-value,
Mann-
Witney
30 days 5.5 ± 1.1 5.1 ± 0.9 7.2 ± 0.8
60 days 6.1 ± 1.0 5.7 ± 1.1 8.0 ± 1.0
180 days 6.2 ± 1.1 6.3 ± 0.8 7.6 ± 1.0
Pain reduction, average decrease in NRS
scores PRF TFESI
P-value,
Mann-
Witney
30 days 3.3 ± 1.7 2.9 ± 1.5 0.45
60 days 4.0 ± 1.6 4.0 ± 1.8 0.9
180 days 4.5 ± 1.9 5.5 ± 1.5 0.083
Disability reduction, average decrease in
ODQ scores PRF TFESI P-value,
Student
30 days 10.8 ± 4.3 8.2 ± 5.3 0.025
60 days 13.6 ± 4.5 13.4 ± 6.2 0.89
180 days 17.1 ± 7.3 19.4 ± 5.6 0.17
Tables 3: Treatment outcome for PRF and TFESI procedures over 180-days
follow-up period.
Pain level (NRS scores) reduction
Improvement, Day 30 Day 60 Day 180
% PRF TFESI PRF TFESI PRF TFESI
0-20 17% 20% 11% 12% 12%
20-40 26% 31% 3% 21% 3%
40-60 23% 46% 40% 38% 24% 33%
60-80 29% 3% 34% 24% 42% 37%
80-100 6% 11% 6% 18% 30%
Disability level (ODQ scores) reduction
Improvement, Day 30 Day 60 Day 180
% PRF TFESI PRF TFESI PRF TFESI
0-20 9% 29% 6% 15% 9%
20-40 37% 43% 17% 21% 9%
40-60 40% 23% 46% 35% 21% 30%
60-80 9% 6% 14% 24% 18% 27%
80-100 6% 17% 6% 42% 43%
Tables 4: Distribution of treatment outcomes for individual patient after PRF and
TFESI procedures over 180-days follow-up period.

Mihails Arons, et al., Clinics in Surgery - General Surgery
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lumbar stenosis, the future studies are requested about PRF treatment.
One of the latest and most unique studies compared PRF and local
anesthetics epidural administration. De et al. [18] in a prospective,
triple-blind, randomized, active control trial compared PRF of DRG
and Transforaminal Epidural Local Anesthetic Injection (TFLAI)
in patients with chronic LRP Patients aged a little bit younger than
ours and with LRP aer unsuccessful treatment by medication for >3
months received a selective diagnostic nerve root block with 1 mL 2%
lidocaine. 50 patients with a positive response were then divided into
PRF and LA groups, each with 25 people. e PRF group received 3
cycles of PRF and the TFELAI group received 1 mL 0.5% bupivacaine.
Both groups were observed aer 2 weeks, 2 months, 3 months and
6 months, which is also similar to our trial. e described study
outcome didn’t show a signicant dierence between the TFLAI and
PRF groups in all baseline variables. However, reductions in VAS
and ODQ scores were statistically signicant at all time intervals
(2-6 months) in both groups. Authors concluded that TFLAI with
PRF of the DRG resulted in signicant pain relief and functional
improvement compared to the TFLAI patients’ group [18].
Our results demonstrated that there were no signicant
dierences between DRG PRF and TFESI, what coexists to other
colleague’s research. So, there were no signicant dierences between
the PRF group and the TFESI group in terms of age and sex were
mentioned [17]. However, we observed that the ODQ index 30
days aer treatment was lower in the PRF group compared to the
TFESI group. Moreover, on day 30, 57% of our patients from the
TFESI group and 49% from the PRF group received an additional
procedure. On average, the NRS scale 30 days aer therapy decreased
by 3.3 points using PRF and by 2.9 points aer TFESI. Considering
these facts, we could suppose that DRG PRF treatment has a more
expressed short-term eect. In turn, aer 60 days the NRS in both
groups was the same – 4. Commonly, we agree that PRF treatment
has progressively gained a place in the management of chronic pain
syndromes [11]. However, long-lasting eects seems to be better aer
180-day follow-up in the TFESI group because here the patients had
a better outcome (5.5) based on the NRS scale than the PRF group
[18,19]. is allows us to conclude that PRF has no longer eect
than that of TFESI. ere is strong evidence that lumbar TFESI is an
eective treatment for radicular pain with or without radiculopathy
due to disc herniation. TFESI is a popular treatment not only among
our pain physicians, but worldwide.
We also completely agree with the De et al. [18], that PRF of
the DRG is one of the most widely used modalities for management
of LRP for those not responding to conventional treatment. PRF
of the DRG involves a simple procedure, is low cost, and has a low
complication rate. Also, our trial didn’t show signicant neurological
complications aer PRF management, as in the study by Cahana et
al. [20].
Our results prove that PRF is good treatment method for many
patients who suer from chronic unilateral lumbosacral radicular
pain with radiculopathy because the eects of PRF can persist for
at least 6 months aer the procedure without any complications
[21]. However, not ignorable are data of other colleagues, who
reported lack of sucient evidence of DRG PRF in LRP, since only
observational studies were reported.
Abejon et al. [22] and also Simpoulos et al. [23] reported
signicant data about improvement in patients with LRP, who
received DRG PRF. Most of these studies alike use NRS and GPE for
outcome quality of life and pain relief to report improvement.
In four other prospective studies, PRF also was found to be
eective in the treatment of patients with LRP [10,19,24,25]. Chang
et al. [26] in retrospective conducted study with chronic lumbosacral
radicular pain aer postlumbar surgery syndrome, who received PRF
therapy, also had successful result.
ere have not been many trials where PRF of DRG treatment
was compared with other modalities in patients with LRP. Koh et al.
[17] who compared PRF of the DRG with TFESI and TFESI group
alone concluded that treatment method combinations signicantly
decrease NRS score and increase GPE, much more than patients
receiving TFESI alone at 2 and 3 months, respectively.
Conclusion
e eectiveness of DRG PRF and TFESI by evaluation of three
assessment’s tools: GPE, NRS and ODQ demonstrates the eciency
of the PRF in short-term response (30 days follow-up) due to the
notably higher decrease in ODQ scores in PRF than into the TFESI
group, despite of similar GPE and NRS scores in both groups.
TFESI procedure is more eective in long-term perspective,
proved by slightly higher proportion of patients with pain reduction
more than 60% and lower proportion of patients with improvement
less than 40% both for NRS and ODQ scores at the day 180.
Ethical Approval
e local Ethics Committee of Riga Stradins University approved
this research.
Informed Consent
e patient provided informed consent for the publication of this
report.
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