Journal of Shandong University (Health Sciences) ›› 2018, Vol. 56 ›› Issue (7): 76-80.doi: 10.6040/j.issn.1671-7554.0.2017.993

Previous Articles    

Dorsal root ganglion pulsed radiofrequency combined with lumbar lateral recess block in the treatment of lumbar spinal stenosis

XING Qianqian, FU Zhijian   

  1. Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China
  • Published:2022-09-27

PDF (PC)

56

Abstract: Objective To investigate the clinical efficacy and safety of dorsal root ganglion(DRG)pulsed radiofrequency(PRF)combined with lumbar lateral recess block in treatment of lumbar spinal stenosis(LSS). Methods A total of 40 patients with LSS treated with DRG-PRF combined with lateral recess block during June 2014 and June 2017 were enrolled as the observation group, and 40 patients with LSS treated with simple lateral recess block served as the control group. The visual analogue scale(VAS)was observed before treatment, 1 week, 1 month, 3 months and 6 months after treatment. The results were graded as excellent, good, fair or poor based on modified MacNab criteria. The possible risk factors affecting the curative effect were analyzed with Logistic regression. The complications and adverse reactions were recorded. Results There were no significant differences between the two groups in age(P=0.646), gender(P=0.823)and VAS scores before treatment(P=0.945). VAS scores decreased significantly after treatment in both groups(P<0.001), but the observation group had a more remarkable decrease 3 months(P=0.011)and 6 months(P=0.040)after trealment. The observation group had higher excellent and good rates 1 month(P=0.014)and 6 months(P=0.013)after treatment than the control group. Logistic regression analysis indicated that the curative effect was better in the observation group. No serious complications were observed in the observation group, while spondylodiscitis occurred in 2 cases in the control group. Conclusion The combination of DRG-PRF and lumbar lateral recess block shows better efficacy than simple lumbar lateral recess block in the treatment of LSS.

Key words: Dorsal root ganglion, Pulsed radiofrequency, Lateral recess block, Lumbar spinal stenosis

CLC Number: 

  • R614
[1] 毛克亚, 王岩, 肖嵩华, 等. 微创手术治疗单节段腰椎管狭窄症的疗效评价[J].中国脊柱脊髓杂志, 2011, 21(2): 113-117. MAO Keya, WANG Yan, XIAO Songhua, et al. Outcomes of minimally invasive treatment for single level lumbar stenosis [J]. Chinese Journal of Spine and Spinal Cord, 2011, 21(2): 113-117.
[2] 唐运章, 丁义良, 刘梅, 等. 单节段腰椎后部结构逐级切除对脊柱三维运动稳定性的影响[J]. 中华实验外科杂志, 2005, 22(7): 845-846. TANG Yunzhang, DING Yiliang, LIU Mei, et al. The effect on stability of lumbar spine 3D motions following monolevel posterior structure gradual resection [J]. Chinese Journal of Experimental Surgery, 2005, 22(7): 845-846.
[3] Manchikanti L. Role of neuraxial steroids in interventional pain management [J]. Pain Physician, 2002, 5(2): 182-199.
[4] 谢蔚影, 徐建国. 糖皮质激素在慢性疼痛治疗中的作用[J].医学研究生学报, 2007, 20(12): 1318-1321. XIE Weiying, XU Jianguo. Roles of glucocorticoids in the management of chronic pain[J]. Journal of Medical Postgraduates, 2007, 20(12): 1318-1321.
[5] MacNab I. Negative disc exploration An analysis of the causes of nerve-root involvement in sixty-eight patients [J]. J Bone Joint Surg Am, 1971, 53(5): 891-903.
[6] Djurasovic M, Glassman SD, Carreon LY. Contemporary management of symptomatic lumbar spinal stenosis [J]. Orthop Clin North Am, 2010, 41(2): 183-191.
[7] Lumbar spinal stenosis. A retrospective study of 163 cases in southern Sweden [J]. Acta Orthop Scand, 1995, 66(5): 403-405.
[8] Siebert E, Prüss H, Klingebiel R, et al. Lumbar spinal stenosis: syndrome, diagnostics and treatment [J]. Nat Rev Neurol, 2009, 5(7): 392-403.
[9] Risbud MV. Role of cytokines in intervertebral disc degeneration: pain and disc content [J]. Nat Rev Rheumatol, 2014, 10(1): 44-56.
[10] 张琰, 孟阳, 赵卫东, 等. 腰椎管内静脉血清中炎性因子与腰椎管狭窄的关系[J]. 中国组织工程研究, 2014, 18(26): 4229-4235. ZHANG Yan, MENG Yang, ZHAO Weidong, et al. Relationship between lumbar spinal stenosis and inflammatory factors in the vein serum of lumbar spinal canal [J]. Chinese Journal of Tissue Engineering Research, 2014, 18(26): 4229-4235.
[11] Delport EG, Cucuzzella AR, Marley JK, et al. Treatment of lumbar spinal stenosis with epidural steroid injections: a retrospective outcome study[J]. Arch Phys Med Rehabil, 2004, 85(3): 479-484.
[12] Botwin KP, Gruber RD, Bouchlas CG, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study [J]. Am J Phys Med Rehabil, 2002, 81(12): 898-905.
[13] Liu K, Liu P, Liu R, et al. Steroid for epidural injection in spinal stenosis: a systematic review and meta-analysis [J]. Drug Des Devel Ther, 2015, 9: 707-716. doi: 10.2147/DDDT.S78070.
[14] Friedly JL, Comstock BA, Turner JA, et al. Long-term effects of repeated injections of local anesthetic with or without corticosteroid for lumbar spinal stenosis: a randomized trial [J]. Arch Phys Med Rehabil, 2017, 98(8): 1499-1507.
[15] Kim K, Jo D. Pulsed radiofrequency to the dorsal root ganglion in acute herpes zoster and postherpetic neuralgia [J]. Pain Physician, 2017, 20(3): 411-418.
[16] Malik K. Radiofrequency applications to dorsal root ganglia: a literature review [J]. Anesthesiology, 2008, 109(3): 527-542.
[17] Van Zundert J, Harney D, Joosten EA, et al. The role of the dorsal root ganglion in cervical radicular pain: diagnosis, pathophysiology, and rationale for treatment [J]. Reg Anesth Pain Med, 2006, 31(2): 152-167.
[18] Mehta V, Snidvongs S, Ghai B, et al. Characterization of peripheral and central sensitization after dorsal root ganglion intervention in patients with unilateral lumbosacral radicular pain: a prospective pilot study [J]. Br J Anaesth, 2017, 118(6): 924-931.
[19] Guo W, Zou S, Guan Y, et al. Tyrosine phosphorylation of the NR2B subunit of the NMDA receptor in the spinal cord during the development and maintenance of inflammatory hyperalgesia [J]. J Neurosci, 2002, 22(14): 6208-6217.
[20] Lee DG, Ahn SH. Comparative effectivenesses of pulsed radiofrequency and transforaminal steroid injection for radicular pain due to disc herniation: a prospective randomized trial [J]. J Korean Med Sci, 2016, 31(8): 1324-1330.
[21] Van Boxem K, de Meij N, Kessels A, et al. Pulsed radiofrequency for chronic intractable lumbosacral radicular pain: a six-month cohort study [J]. Pain Med, 2015, 16(6): 1155-1162.
[22] Koh W, Choi SS, Karm MH, et al. Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: a randomized controlled study [J]. Pain Med, 2015, 16(3): 432-441.
[23] Chang MC. Effects of pulsed radiofrequency on spasticity in patients with spinal cord injury: a report of two cases [J]. Neural Regen Res, 2017, 12(6): 977-980.
[24] Hagiwara S, Iwasaka H, Takeshima N. Mechanisms of analgesic action of pulsed radiofrequency on adjuvant-induced pain in the rat: roles of descending adrenergic and serotonergic systems [J]. Eur J Pain, 2009, 13(3): 249-252.
[25] Van Zundert J, de Louw AJ, Joosten EA, et al. Pulsed and continuous radiofrequency current adjacent to the cervical dorsal root ganglion of the rat induces late cellular activity in the dorsal horn [J]. Anesthesiology, 2005, 102(1): 125-131.
[26] Hunter JC, Woodburn VL, Durieux C, et al. c-fos antisense oligodeoxynucleotide increases formalin-induced nociception and regulates preprodynorphin expression [J]. Neuroscience, 1995, 65(2): 485-492.
[27] Tanaka N, Yamaga M, Tateyama S, et al. The effect of pulsed radiofrequency current on mechanical allodynia induced with resiniferatoxin in rats [J]. Anesth Analg, 2010, 111(3): 784-790.
[28] Protasoni M, Reguzzoni M, Sangiorgi S, et al. Pulsed radiofrequency effects on the lumbar ganglion of the rat dorsal root: a morphological light and transmission electron microscopy study at acute stage [J]. Eur Spine J, 2009, 18(4): 473-478.
[29] Li X, Ni J, Yang L, et al. A prospective study of Gasserian ganglion pulsed radiofrequency combined with continuous radiofrequency for the treatment of trigeminal neuralgia [J]. J Clin Neurosci, 2012, 19(6): 824-828.
[1] FU Jia, WANG Lulu, HU Shuai, CHEN Zheping, LIU Dongyi, LI Qingsong, LU Guodong, ZHANG He, ZHAO Xin, FENG Chang. Effects of different approaches of quadrates lumborum block on postoperative recovery of patients undergoing radical gastrectomy [J]. Journal of Shandong University (Health Sciences), 2022, 60(8): 50-57.
[2] BU Huimin, TIAN Xiaopeng, LIU Jinshan, TAN Gang. Effect of intrathecal injection of low-dose bupivacaine coadministered with sufentanil in procedure for prolapse and hemorrhoids [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(3): 117-120.
[3] XIE Hai, LI Yan, ZHOU Qi. Assessment of skin temperature changes in determining success of transversus abdominis plane block [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(1): 71-74.
[4] ZHENG Juan, LI Zheng, ZHANG Wenjing, YUAN Linran, FAN Shubo, LIU Yugang, YUAN Zhongrui. Role of Caveolin-1 in postischemic angiogenesis in a rat model of ischemic stroke [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(10): 16-20.
[5] CHEN Haili, GU Jiaoyang, ZHANG Wenjing, YUAN Linran, ZHENG Juan, YUAN Zhongrui. Involvement of canonical Wnt pathway in postischemic angiogenesis in a rat model of ischemic stroke [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(4): 31-36.
[6] . [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(S2): 29-30.
[7] . [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(S2): 37-38.
[8] . [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(S2): 69-70.
[9] . [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(S2): 119-120.
[10] DING Chao, HU Qiya, HUANG Haizhen, GUO Yaqiu, PEI Miao, ZHU Qingzeng, QI Feng. Effect of slow-released betamethasone dipropionate microparticles on neuropathic pain in rat spinal cord and expression of extracellular signal-regulated kinase [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(10): 35-39,44.
[11] HUANG Haizhen1, HU Qiya1, DING Chao1, GUO Yaqiu1, QI Feng1, REN Jie2, PAN Xiaojun1. Long-term effect of sciatic nerve block with ropivacaine PEG-PLA microparticles in a rat model of postoperative pain [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(3): 50-55.
[12] SUN Chuan-yu, GUO Lei, BI Yan-bin. Application of ultrasound-guided combined femoral-sciatic nerve block in patients treated with anticoagulants undergoing  ligation and stripping of great saphenous vein [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2013, 51(10): 77-80.
[13] HUANG Jing-yang1, YANG Cheng-hui1, MA Kun-run1, LIU Xi1, WANG Yi-fei1, CHEN Hai-li1, LIU Bao-yi2, YUAN Zhong-rui1. Acute hyperglycemia worsens ischemic stroke-induced blood-brain barrier impairment via HMGB1 in rats [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2013, 51(9): 17-21.
[14] LI Hui1，HUANG Jing-yang1, CHEN Hai-li1,　LIU Bao-yi2, YUAN Zhong-rui1. Expression and location of Wnt7b in  rat subgranular zone of  hippocampus dentate gyrus after cerebral ischemia-reperfusion [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2013, 51(2): 7-11.
[15] DING Ming1， ZONG Bo1， WANG Xue-ping2. Protective mechanisms of fentanil and methylprednisolone sodium succinate
on ischemia-reperfusion injury after rabbit limb replantation [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2012, 50(9): 55-58.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd