1Shaaban Abdelhady Abdelmawla Omar, 1Sherif El-Sayed Hegab, 1Mohamed Ihab Samy Reda, 2Sahar Ahmed El-Karadawy, 1Mowaffak Moustafa Saad, 1Omar Sameh Elaassar, 1Nancy Mohamed El Sekily
1Faculty of Medicine, Alexandria University, Alexandria, Egypt; 2Medical Research Institute, Alexandria University, Alexandria, Egypt
The current study was performed to measure accuracy and safety of US-guided lumbar transforaminal pulsed radiofrequency(PRF) of dorsal root ganglion (DRG) confirmed by fluoroscopic imaging (FL) in management of chronic radicular pain (CRP).
Material(s) and Method(s):
After taking ethical committee approval and patients’ consents, the current study conducted on 32 patients with CRP due to lumbar disc herniation. The US curved probe was used in parasagittal oblique plane for cephalic counting to desired vertebral level starting from sacral hiatus, then in transverse plane for visualization of the details of vertebra and directing RF cannula in plane from lateral to medial towards lateral border of articular process (AP) . The angle of the cannula decreased on patient’s surface when cannula advanced medially, superiorly and anteriorly to AP towards DRG. The correct placement of the cannula was confirmed by FL , sensory and motor stimulation before application of PR for 4 min. The primary outcome measured the degree of accuracy of US guided transforaminal PR cannula placement adjacent to the desired DRG, secondary outcomes were pain relief, analgesic consumption ,Patients’ functionality and safety of the technique.
A 32 patients, with 34 lumbar interventions was included in the study. A 31 interventions out of 34 was performed successfully with overall accuracy of 91.18% and with minimal complications. The successful first trial placement of the cannula was calculated in 44.1% of interventions , multiple trials were needed in 47.1 % while incorrect level was encountered in 8.8%. Visual analogue scale of pain,and Oswestry Disability index decreased significantly after intervention up to 3 months compared to the pre-intervention value. The analgesic consumption was reduced by mean of 73.44±31.07 % one month after intervention.
US guided fluoroscopic verified transforaminal PR of lumbar DRG is accurate, safe and effective for CRP.