Bel ağrısında pulsed ve konvansiyonel radyofrekans termokoagulasyon uygulamaları

Amaç: Günümüzde bel ağrısı önemli bir sağlık sorunudur. Radyofrekans (RF) tedavisi, hedeflenen dokuya enerji transferi ile farklı sıcaklık seviyeleri üretir ve bel ağrısına sahip hastalarda etkin bir tedavi yöntemi olabilir. Bu çalışmada, lumbar bel ağrısına sahip hastalarda arka kök ganglionuna uygulanan pulsed ve konvansiyonel radyofrekansın etkilerinin karşılaştırılması amaçlandı.Gereç ve Yöntem: Bu çalışma için üç aydan daha uzun süre bel ağrısına sahip 30 hasta kabul edildi, pulsed (42 0C, 240 s) (n=15) ve konvansiyonel (65 0C, 120 s) (n=15) radyofrekans uygulandı. Hastaların işlem öncesi ve işlem sonrası 1 ve 3. aylarda ağrıları Visual Analog Skala (VAS) ve fonksiyonel aktiviteleri modifiye Oswestry Disability İndeks (ODİ) ile değerlendirildi. Nörolojik muayeneleri kaydedildi.Bulgular: Her iki grupta VAS ve modifiye ODİ değerleri 1. ve 3. aylarda işlem öncesine göre istatistiki olarak anlamlı derecede düşüktü. Ancak iki grup arasında istatiksel farklılık bulunmadı. Motor, sensoryal ve refleks kaybı değerlendirdiğimiz nörolojik muayenede gruplar arasında fark yoktu.Sonuç: Bel ağrısına sahip hastalarda uygulanan pulsed ve konvansiyonel radyofrekans yöntemleri benzer etkilere sahipti. Daha yüksek dereceler avantaj sağlamamaktadır. Olası yan etkilerden kaçınmak için dorsal kök ganglionuna uygulanan pulsed radyofrekans güvenli ve etkin bir yöntemdir.

Anahtar Kelimeler:

Low back pain, pulsed radiofrequency treatments

Pulsed and conventional radiofrequency thermocoagulation applications on low back pain

Purpose: Nowadays, low back pain (LBP) is an important health problem. Radiofrequency (RF) treatments can generate different temperature levels by transferring energy to the targeted tissue, and which is an effective interventional treatment method for LBP patients. In this study, we compared the effects of pulsed and conventional RF treatments on patients with LBP.Materials and Methods: Thirty patients with LBP histories for longer than three months received pulsed (42 0C, 240 s) (n=15) and conventional (65 0C, 120 s) (n=15) RF treatments. The baseline and one and three months after the procedure, the patients’ pain and disability values were obtained using a Visual Analogue Scale (VAS) and the modified Oswestry Disability Index (ODI), respectively. The results of the patients’ neurological examinations were also recorded. Results: The VAS and modified ODI values were reduced in both groups one and three months after the RF treatments when compared to the baseline values . However, no statistically significant differences were found between the two groups. In addition, there were no statistically significant differences between the two groups in terms of the neurological examination results involving motor, sensorial, and reflex losses. Conclusion: The pulsed and conventional RF treatments exhibited similar effects in the LBP patients. Therefore, higher temperatures do not provide an advantage. Pulsed RF treatment applied to the dorsal root ganglion is a safe and effective way to avoid possible side effects.

Keywords:

: Low back pain pulsed radiofrequency treatments, dorsal root ganglion,

PDF

___

1. Bjorland S, Roe C, Moen A, Schistad E, Mahmood A, Gjerstad J. Genetic predictors of recovery in low back and lumbar radicular pain. Pain. 2017;158:1456-60.
2. Chao SC, Lee HT, Kao TH, Yang MY, Tsuei YS, Shen CC et al. Percutaneous pulsed radiofrequency in the treatment of cervical and lumbar radicular pain. Surg Neurol. 2008;70:59-65.
3. Leggett LE; Soril LJ; Lorenzetti DL; Noseworthy T; Steadman R; Tiwana S et al. Radiofrequency ablation for chronic low back pain: a systematic review of randomized controlled trials. Pain Res Manag. 2014;19: e146-53.
4. Kim JH, Yu HY, Park SY, Lee SC, Kim YC. Pulsed and conventional radiofrequency treatment: which is effective for dental procedure-related symptomatic trigeminal neuralgia? Pain Med. 2013;14:430-5.
5. Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep. 2008;12:37-41.
6. van Kleef M, Liem L, Lousberg R, Barendse G, Kessels F, Sluijter M. Radiofrequency lesion adjacent to the dorsal root ganglion for cervicobrachial pain: a prospective double blind randomized study. Neurosurgery. 1996;38:1127-31.
7. Tsou HK, Chao SC, Wang CJ, Chen HT, Shen CC, Lee HT et al. Percutaneous pulsed radiofrequency applied to the L-2 dorsal root ganglion for treatment of chronic low-back pain: 3-year experience. J Neurosurg Spine. 2010;12:190-6.
8. van Wijk RM, Geurts JW, Wynne HJ. Long-lasting analgesic effect of radiofrequency treatment of the lumbosacral dorsal root ganglion. J Neurosurg. 2001;94:227-31.
9. Chang MC, Cho YW, Ahn SH. Comparison between bipolar pulsed radiofrequency and monopolar pulsed radiofrequency in chronic lumbosacral radicular pain: A randomized controlled trial. Medicine (Baltimore). 2017;96:e6236.
10. Geurts 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;361:21-6.
11. Koh W, Choi SS, Karm MH, Suh JH, Leem JG, Lee JD et al. Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: a randomized controlled study. Pain Med. 2015;16:432- 41.
12. Simopoulos TT, Kraemer J, Nagda JV, Aner M, Bajwa ZH. Response to pulsed and continuous radiofrequency lesioning of the dorsal root ganglion and segmental nerves in patients with chronic lumbar radicular pain. Pain Physician. 2008;11:137-44.
13. Yakut E, Duger T, Oksuz C, Yorukan S, Ureten K, Turan D et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976). 2004;29:581-5.
14. Chen HN, Tsai YF. A predictive model for disability in patients with lumbar disc herniation. J Orthop Sci. 2013;18:220-9.
15. Haspeslagh SR, Van Suijlekom HA, Lame IE, Kessels AG, van Kleef M, Weber W E. Randomised controlled trial of cervical radiofrequency lesions as a treatment for cervicogenic headache. BMC Anesthesiol. 2006;6:1.
16. van Kleef M, Spaans F, Dingemans W, Barendse GA, Floor E, Sluijter ME. Effects and side effects of a percutaneous thermal lesion of the dorsal root ganglion in patients with cervical pain syndrome. Pain 1993;52:49-53.
17. Van Boxem K, van Bilsen J, de Meij N, Herrler A, Kessels F, Van Zundert J et al. Pulsed radiofrequency treatment adjacent to the lumbar dorsal root ganglion for the management of lumbosacral radicular syndrome: a clinical audit. Pain Med. 2011;12:1322-30.
18. Van Boxem K, de Meij N, Kessels A, Van Kleef M, Van Zundert J. Pulsed radiofrequency for chronic intractable lumbosacral radicular pain: a six-month cohort study. Pain Med. 2015;16:1155-62.
19. Erdine S, Yucel A, Cimen A, Aydin S, Sav A, Bilir A. Effects of pulsed versus conventional radiofrequency current on rabbit dorsal root ganglion morphology. Eur J Pain. 2005;9:251-6.
20. Vatansever D, Tekin I, Tuglu I, Erbuyun K, Ok G. A comparison of the neuroablative effects of conventional and pulsed radiofrequency techniques. Clin J Pain. 2008;24:717-24.
21. Slappendel R, Crul BJ, Braak GJ, Geurts JW, Booij LH, Voerman VF et al. The efficacy of radiofrequency lesioning of the cervical spinal dorsal root ganglion in a double blinded randomized study: no difference between 40 degrees C and 67 degrees C treatments. Pain. 1997;73:159-63.
22. Dobrogowski J, Wrzosek A, Wordliczek J. Radiofrequency denervation with or without addition of pentoxifylline or methylprednisolone for chronic lumbar zygapophysial joint pain. Pharmacol Rep. 2005;57:475-80.
23. Roy C, Chatterjee N, Ganguly S, Sengupta R. Efficacy of combined treatment with medial branch radiofrequency neurotomy and steroid block in lumbar facet joint arthropathy. J Vasc Interv Radiol. 2012;23:1659-64