Dorsal root ganglion pulsed radiofrequency vs. transforaminal epidural steroid injection: prospective randomized study

Pulsed Radiofrequency (PRF) procedures are a minimally invasive and target-selective modality procedure. PRF procedure becoming an increasingly used treatment for chronic radicular pain and competitive with Transforaminal Epidural Steroid Injection (TFESI). A prospective randomized, blind control study was performed to evaluate the therapeutic effect of lumbar Dorsal Root Ganglion (DRG) PRF treatment and lumbar TFESI. The study included a total of 72 patients, 35 were randomized to PRF group, 35 patients - to TFESI group. The outcome of the treatment either by PRF or TFESI was evaluated by Global Perceiving Effect (GPE) and decrease in NRS and Oswestry Disability Questionnare (ODQ) at day 30, 60 and 180. After 30th day follow-up, patients with Likert scores ≤ 5 had received the identical procedure. Global perceived effect (GPE) increased with time for both PRF and TFESI groups, reached at day 180 follow-up 6.2 for PRF and 6.3 for TFESI. Statistical comparison of improvements, caused by PRF and TFESI does not revealed significant difference in the treatment outcomes. Generally values of GPE, decrease of NRS and decrease of ODQ was similar for PRF and TFESI groups. The only exception was decrease in ODQ scale at the day 30 that was higher for PRF treatment (P-value 0.02). Alongside, in PRF group there was only 9% of patients with less than 20% improvement in disability, as compared with 29% in TFESI group. But at the day 180, the proportion of patient with pain reduction more than 60% in TFESI group exceeded one for PRF group. The effectiveness of DRG PRF and TFESI by evaluation of GPE, NRS and ODQ demonstrates the efficiency of the PRF in short-term response, despite of similar GPE and NRS scores in both groups. TFESI procedure is more effective in long-term perspective, proved by higher proportion of patients with pain reduction.