Abstract

ESPARZA-MINANA, J.M. et al. Pulsed radiofrequency of the thoracic dorsal root ganglion with epidural catheter-electrode. A new approach for an effective treatment. Rev. Soc. Esp. Dolor [online]. 2018, vol.25, n.1, pp.45-50. ISSN 1134-8046.  https://dx.doi.org/10.20986/resed.2017.3611/2017.

Pulsed radiofrequency (pRF) has been used for the treatment of peripheral nerves and the dorsal root ganglion (DRG). It has been commonly applied for the treatment of low back pain, neck pain and neuropathies with very good results. The dorsal root ganglion is an anatomical structure that is located bilaterally at the distal end of the dorsal root in the lateral epidural space. Most of the thoracic GRDs are located in the medial cranial part of the intervertebral foramina. Patients with thoracic pain radiated following a segmental pattern, which do not respond to conservative treatment, are susceptible to treatment by pRF from the DRG. In order to overcome the technical difficulties in access to thoracic GRD and to minimize the possible iatrogenic complications derived from the traditional percutaneous technique, we decided to perform the pRF technique in GRD at the thoracic level with epidural catheter by approaching the epidural space via translaminar in two patients with thoracic radiculopathy.

Treatment of the dorsal root ganglion at the lumbar level is a widespread therapy in patients with chronic low back pain. Various studies and reviews support the realization of this technique.

However, thoracic radicular pain is not a typical clinical syndrome such as in the lumbar area. There are different pain patterns: constant or intermittent pain, nociceptive or neuropathic pain or a combination of these. The PAIN DETECT questionnaire was specifically developed to detect the components of neuropathic pain in adults. Treatment of DRG using pRF with an epidural approach performed in the cases described has been shown to be effective. We obtained a good success rate with a decrease in NRS of more than 50% in both cases, with the practical disappearance of the neuropathic component of pain. The approach through the epidural canal via translaminar provides great safety emerging as an adequate option to decrease the rate of serious complications.

Keywords : Pulsed radiofrequency; dorsal root ganglion (DRG); epidural catheter; "Pain detect".

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