Chang Min Cheol
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
Medicine (Baltimore). 2017 Apr;96(15):e6604. doi: 10.1097/MD.0000000000006604.
Despite undergoing transforaminal epidural steroid injection (TFESI), many patients complain of persisting cervical radicular pain. For the management of chronic cervical radicular pain, clinicians are widely applying pulsed radiofrequency (PRF) stimulation to dorsal root ganglions (DRGs). To enhance the effect of PRF stimulation, we conducted bipolar PRF stimulation in 2 patients with chronic cervical radicular pain that was refractory to monopolar PRF and repeated TFESIs.
Patients 1 and 2 presented with a numeric rating scale (NRS) score of 7 and 6 for chronic cervical radicular pain, respectively, despite undergoing monopolar PRF and 2 TFESIs.
On cervical magnetic resonance imaging, foraminal stenosis at the right C6-7 and right central to right foraminal disc protrusion on C6-7 were observed in patients 1 and 2, respectively. Two patients showed a positive response on diagnostic right C7 selective nerve root block with 0.5 mL of 1% lidocaine.
Bipolar PRF stimulation was performed under C-arm fluoroscopy. Two parallel RF cannulas (less than 1 cm apart) were used for DRG stimulation. The PRF treatment was administered at 5 Hz and a 5-ms pulsed width for 360 seconds at 45 V with the constraint that the electrode tip temperature did not exceed 42°C.
At the 2-week and 1-month follow-up, after undergoing bipolar PRF, the pain of patient 1 was completely relieved, and at 2, 3, and 6 months, the pain was scored as NRS 2. In patient 2, at the 2-week follow-up after undergoing bipolar PRF, pain severity was reduced from NRS 6 to 2. The effect of bipolar PRF on patient 2 lasted for at least 6 months. No adverse effects were observed in either patient.
Application of bipolar PRF to DRGs seems to be an effective and safe technique for treating refractory chronic cervical radicular pain.
尽管接受了经椎间孔硬膜外类固醇注射（TFESI），许多患者仍抱怨存在持续的颈神经根性疼痛。对于慢性颈神经根性疼痛的治疗，临床医生广泛应用脉冲射频（PRF）刺激背根神经节（DRG）。为增强PRF刺激的效果，我们对2例经单极PRF和反复TFESI治疗无效的慢性颈神经根性疼痛患者进行了双极PRF刺激。
患者1和患者2尽管接受了单极PRF和2次TFESI治疗，但慢性颈神经根性疼痛的数字评分量表（NRS）评分分别为7分和6分。
颈椎磁共振成像显示，患者1为右侧C6 - 7椎间孔狭窄，患者2为右侧C6 - 7中央至右侧椎间孔椎间盘突出。2例患者在诊断性右侧C7选择性神经根阻滞时，注射0.5毫升1%利多卡因后均显示阳性反应。
在C形臂荧光透视下进行双极PRF刺激。使用两根平行的射频套管（间距小于1厘米）进行DRG刺激。PRF治疗以5赫兹、5毫秒脉冲宽度、45伏进行360秒，同时限制电极尖端温度不超过42°C。
在双极PRF治疗后的2周和1个月随访中，患者1的疼痛完全缓解，在2个月、3个月和6个月时，疼痛评分为NRS 2分。在患者2中，双极PRF治疗后2周随访时，疼痛严重程度从NRS 6分降至2分。双极PRF对患者
