Pain Medicine Department, Santa Maria Maddalena Hospital, Occhiobello, Italy.
Pain Pract. 2021 Mar;21(3):277-284. doi: 10.1111/papr.12955. Epub 2020 Oct 25.
Scientific data about neurophysiological changes subsequent to pulsed radiofrequency (PRF) are still lacking. The goal of this study was to evaluate sural nerve conduction and Hoffmann reflex (H-reflex) in soleus muscle following adhesiolysis and PRF in patients with unilateral chronic lumbosacral L5-S1 neuropathic radiating pain.
Seventeen patients received two cycles of 240 seconds high-voltage PRF and epidural adhesiolysis. Sural nerve action potential (SNAP) and the ratio of maximum H-reflex to maximum M response (H/M ratio) as well as pain scores were collected in both lower limbs before, immediately following, and 1 month after the treatment.
At follow-up, a significant reduction in numeric rating scale (NRS) and Douleur Neuropathique 4 Questions (DN4) scores was observed in 53% of patients reporting pain improvement of ≥ 30% over baseline. The H/M ratio was decreased in the affected limb following PRF (P = 0.01) and 1 month after the treatment (P = 0.04). A direct correlation was observed between H/M ratio variation and NRS score at follow-up in the treated limb (P = 0.04). No significant difference in sural nerve latency, amplitude, and velocity was detected between affected and normal side after treatment and at follow-up.
Epidural adhesiolysis and PRF of the dorsal root ganglion seem to significantly affect spinal reflexes in patients with lumbosacral neuropathic radiating pain.
脉冲射频（PRF）后神经生理变化的科学数据仍然缺乏。本研究的目的是评估单侧慢性腰骶部 L5-S1 神经性放射痛患者粘连松解和 PRF 后腓肠神经传导和比目鱼肌 Hoffmann 反射（H 反射）的变化。
17 例患者接受了 2 个周期 240 秒的高压 PRF 和硬膜外粘连松解。在治疗前、治疗后即刻和 1 个月时，分别在双侧下肢收集腓肠神经动作电位（SNAP）和最大 H 反射与最大 M 反应比值（H/M 比值）以及疼痛评分。
在随访时，53%的疼痛改善≥30%的患者报告数字评分量表（NRS）和 4 项神经性疼痛问卷（DN4）评分显著降低。PRF 后（P=0.01）和治疗后 1 个月（P=0.04）患侧 H/M 比值降低。治疗后和随访时，治疗侧 H/M 比值变化与 NRS 评分呈直接相关（P=0.04）。治疗后和随访时，患侧和健侧腓肠神经潜伏期、振幅和速度无显著差异。
硬膜外粘连松解和背根神经节 PRF 似乎明显影响腰骶部神经性放射痛患者的脊髓反射。
