Health Technology Brief

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Pulsed Radiofrequency Application to the Dorsal Root Ganglion for Treatment of Lumbosacral Radicular Pain

May 16, 2019

Health Problem: Lumbosacral radicular pain is generally characterized by pain radiating into 1 or more dermatomes and may be caused by nerve root irritation, inflammation, or compression. Lumbosacral radiculopathy typically refers to sensory or motor loss and can involve a continuum of radicular pain. Both radicular pain and radiculopathy often occur concurrently. Complete or partial resolution occurs within 12 weeks of pain onset in approximately 60% of patients, while 30% of patients experience ongoing pain at least 3 months after onset.

Technology Description: A dorsal root ganglion (DRG) is a cluster of nerve cell bodies in the posterior roots of spinal nerves. DRG are known to participate in the pain signaling process. Pain signals coming from the periphery traverse the DRG to the spinal cord and subsequently to the brain. Pulsed radiofrequency (PRF) application to the DRG is a minimally invasive pain management procedure. The goal of PRF is to provide pain control without the tissue destruction and painful sequelae associated with continuous radiofrequency ablation. The mechanism of action of PRF in pain relief is uncertain but it may be related to effects of PRF on the electrical fields.

Controversy: PRF application to the DRG represents a minimally invasive treatment option for patients suffering from lumbosacral radicular pain that has not responded to conservative measures. PRF avoids the indiscriminate nerve and adjacent tissue damage inherent with continuous radiofrequency ablation. Likewise, PRF lacks the potential for serious adverse effects associated with intrathecal steroid injections. However, the efficacy and durability of the treatment and the criteria for patient selection have not been established.

Key Questions:

  • Does PRF application to the DRG provide pain relief, reduce the need for surgery, and reduce disability or improve function in patients with lumbosacral radicular pain?
  • How does PRF application to the DRG compare with alternative treatments for lumbosacral radicular pain?
  • Is PRF application to the DRG for lumbosacral radicular pain safe?
  • Have definitive patient selection criteria been identified for PRF application to the DRG for lumbosacral radicular pain?