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A minimally invasive procedure in which the energy pulses of a probe are applied directly to the nerve roots near the spine is safe and effective in people with acute low back pain who have not responded to conservative treatment, according to a study presented today meeting of the North American Radiology Society (RSNA).
Lumbar disc herniation is a common, often debilitating, condition that affects discs that act as cushions between the vertebrae of the lower spine. Herniation occurs when the jelly-like material in the center of the disc swells through a tear in the hard outer layer of the disc and exerts pressure on the nerve roots. Herniated discs are often at the origin of sciatica or pain radiating from the lower back to the leg.
Conservative treatment options for herniated discs range from over-the-counter pain medications to corticosteroid injections directly into the affected area of the spine. Those who do not respond may require surgery. In some cases, the entire disc needs to be removed and the vertebra fused to provide stability.
Another technique, pulse-guided CT, applies energy through a CT-guided electrode to the part of the nerve responsible for sending pain signals.
"The pulsed radiofrequency creates a nerve modulation, greatly reducing inflammation and its badociated symptoms," said lead author of the study, Alessandro Napoli, MD, Ph.D., professor of radiology interventional at the Sapienza University of Rome in Italy.
Dr. Napoli and his colleagues have studied the approach in patients with back pain due to lumbar disc herniation and who have not responded to prolonged conservative treatment. In 128 patients, pRF treatment was administered directly under the direction of the scanner at the nerve root. The treatment was applied for 10 minutes.
In comparison, a group of 120 patients received one to three sessions of scanner-guided steroid injection on the same anatomical target without pRF.
The one-year results showed that the scanner-guided PRF was superior to the injection-only strategy. Patients who received a PRF found a greater overall improvement in pain and disability scores during the first year. Relief of leg pain was faster in patients badigned to PRP, and they also reported a faster rate of perceived recovery. The probability of recovery after one year of follow-up was 95% in the pRF group, compared to 61% in the uniquely injected group.
"Based on the results of our study, we propose pulsed radiofrequency to patients with herniated discs and sciatic nerve compression whose symptoms do not benefit from conservative treatment," said Dr. Napoli.
The results of the study are superior to those generally reported for usual care strategies and injections and could help a significant number of patients with sciatic disk compression to avoid surgery, added Dr. Napoli.
The use of PRF could also improve outcomes for patients about to receive corticosteroid injections.
"We learned that when pulsed radiofrequency is followed by a steroid injection, the result is more durable and more effective than injection alone," said Dr. Napoli. "The effect of pulsed radiofrequency is fast and without adverse events."
Today, the treatment of disorders of the spine allows a definitive treatment of symptoms and conditions according to different techniques and technologies.
"Among the different therapies available, pulsed radiofrequency is among the least invasive," said Dr. Napoli. "The treatment lasts 10 minutes and one session was sufficient for a large number of patients treated."
The co-authors are Roberto Scipione, M.D., Fabrizio Andrani, M.D., Susan Dababou, Cristina Marrocchio, Michele Anzidei, M.D. and Carlo Catalano, M.D.
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