A computed tomography (CT)-guided pulsed radiofrequency strategy was superior to an injection-only protocol for improving pain and disability scores in patients with acute or subacute neuroradicular low back pain resulting from lumbar disk herniation, according to a study presented at the Radiological Society of North America’s Annual Meeting, held November 25-30 in Chicago, Illinois.                        

Patients from a single center who had electromyography-confirmed acute or subacute neuroradicular low back pain and who were refractory to usual care were enrolled in this study (n=260). Investigators randomly assigned study participants to receive CT-guided pulsed radiofrequency (n=128) or injection only (conservative care; n=120). Pulsed radiofrequency was conducted using a 22-20 gauge needle-electrode with probe tip directed under CT guidance to the symptomatic dorsal root ganglion. Clinical efficacy and quality of life outcomes were assessed with the visual analog scale and the Oswestry Disability Index and Roland-Morris questionnaires, which were administered at baseline and at 1 week and at 1, 3, 6, and 12 months.

Both treatment groups had a linear decrease in median visual analog scale scores. Patients treated with pulsed radiofrequency vs conservative care reported greater overall improvement in pain and disability in the first year, a more rapid onset of leg pain relief (P <.001 for both), and faster perceived recovery (hazard ratio, 1.97; 95% CI, 1.72-2.22; P <.001). At the 1-year follow-up, the probability for perceived recovery was higher in participants treated with pulsed radiofrequency vs injection only (95% vs 61%, respectively).

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Generalizability of findings may be limited because of the small number of participants from a single center.

“The results of this study are superior to those reported from literature for usual care strategies and injections and may avoid surgery for a substantial number of patients with sciatic disc compression,” the researchers noted.

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Napoli A, Scipione R, Andrani F, Dababou S, Marrocchio C, Anzidei M, Catalano C. CT guided pulsed radiofrequency in patients with acute low back pain and sciatica: 1 year follow-up versus image-guided injection only as control group. Presented at: The Radiological Society of North America Annual Meeting; Nov 25-30, 2018; Chicago, IL.