LONG TERM EFFICACY AND SAFETY OF EPIDURAL PULSED RADIOFREQUENCY FOR CERVICAL RADICULOPATHY

Objectives: Invasive pain procedures on cervical spine arelimited by a low efficacy and potential complications. W ereport a long-term outcome of chronic cervical radicular pain (CCRP) treated with epidural pulsed radiofrequency (ePRF). Methods: Thirtyfive patients (age 56 + 11 years) suffering from neuropathic CCRP (ie, > 8 weeks, painDETECT >18) due to disc herniation and resistant to pharmacological therapy, and with no indication for open surgery, underwent ePRF. Under fluoroscopy, a multifunctional, multichannel epidural catheter (Pulstrode, Bioampere Research Padua, Italy) was inserted at upper thoracic level and guided to the target cervical root ganglion. After having obtained an overlap between electrically-induced paresthesias and metameric pain, a single 50 Hz ePRF was applied for 300 s (target intensity 100 mA, target temperature <42 °C, voltage 65V) and 20 mg triamcinolone was injected at the stimulation site. A second ePRF was allowed in case of decreased analgesia. Patients were assessed with a pain Numeric Rating Scale (NRS) before and up to 24 months after ePRF. Results: An intraforaminal position was achieved in 31 patients (89%). ePRF was repeated at 8–12 and 12–24 months in 8 and 6 patients. At 6 months after ePRF, a significant Pain Relief (>50%) to the arm was seen in 25 patients (81%). Mean pain NRS decreased significantly (p < 0.05) from 7.8 + 2.2 (baseline) to 2.2 + 1.5, 3.8 + 1.7 and 3.8 + 2.1 at 6, 12 and 24 months after the initial ePRF. Dysesthesia intensity and analgesic and neuropathic drug dosages decreased as well. Conclusion: A single or repeated EPRF was effective without complications on neuropathic CCRP for 24 months.