Evaluation of the efficacy of unipolar and bipolar spinal dorsal root ganglion radiofrequency thermocoagulation in the treatment of postherpetic neuralgia

Abstract

Background: Different views have been proposed on the radiofrequency treatment modes and parameters of radiofrequency thermocoagulation of the spinal dorsal root ganglion for the treatment of postherpetic neuralgia (PHN). It is urgent to identify a more effective therapy for patients with PHN. Methods: Patients who underwent radiofrequency thermocoagulation therapy for PHN were retrospectively reviewed and were divided into a radiofrequency thermocoagulation (CRF) and double neddles radiofrequency thermocoagulation (DCRF). The pain scores (numerical rating scale, NRS) were evaluated at the following time points: before the operation, 1 day, 3 months, 6 months, 1 year, and 2 years after operation. The incidence of complications and the degree of pain relief were evaluated. The in vitro ovalbumin experiment was used to indicate the effects of radiofrequency thermocoagulation. Results: Compared with the preoperative NRS scores, the postoperative NRS scores decreased significantly; the NRS scores of the DCRF group was lower than that of the CRF group at all time points from 6 months to 2 years following the operation. The total effective rate of the DCRF group was significantly higher than that of the CRF group at 2 years following the operation. The incidence of numbness in the DCRF group was higher than that noted in the CRF group. The ovalbumin experiments in vitro indicated that the effects of radiofrequency thermocoagulation were optimal when the distance between the two needles was 5 mm. Conclusions: DCRF with a 5 mm spacing exhibits a longer duration and higher effective rate in the treatment of PHN and is worth promoting.

Analysis of Efficacy and Factors Associated with Reccurence After Radiofrequency Thermocoagulation in Patients with Postherpetic Neuralgia: a Long-Term Retrospective and Clinical Follow-Up Study

“…It has been found that patients treated with bipolar RF-TC experience higher treatment efficiency, more significant pain relief, and longer maintenance than monopolar patients after surgery. In the present study, the recurrence rate of bipolar thermocoagulation was lower than that of monopolar, since bipolar RF needle thermocoagulation leads to a more radical destructive effect reaching a greater range of tissues, and therefore has a longer-lasting efficacy [ 19 ]. Patients with preoperative comorbidities such as hypertension, diabetes, coronary artery disease, or malignancy are more prone to recurrence than those without comorbidities [ 30 ].…”

“…Although pulsed radiofrequency (PRF) has been shown to yield definite analgesic efficacy in treating herpes zoster-associated pain, some patients have insignificant pain relief and a high short-term recurrence rate after treatment, and often require additional pain relief treatment [ 15 – 17 ]. Radiofrequency thermocoagulation (RF-TC) enables the destruction of the DRG with significant pain relief and high efficiency [ 18 , 19 ]. Therefore, for patients with PHN, RF-TC may become a effective percutaneous minimally invasive surgical modality to relieve the pain, reduce the recurrence rate, improve sleep, and enhance the quality of life.…”

Current scenario and future applicability of antivirals against herpes zoster

“…Ultimately, it reduces the incidence, severity, and duration of pain and limits neuronal damage [ 1 , 8 ]. The replicated latent VZV leads to inflammatory sensory or motor neural damage of the peripheral and central nervous systems, resulting in zoster-associated pain (ZAP) or postherpetic neuralgia (PHN) [ 1 , 11 ]. In addition to the therapeutic effect of antivirals on HZ itself, the reduction and prevention of ZAP or PHN are also important clinical perspectives [ 1 , 12 , 13 ].…”

Efficacy of Long-Term Spinal Nerve Posterior Ramus Pulsed Radiofrequency in Treating Subacute Herpetic Neuralgia: A Prospective Randomized Controlled Trial

“…PRF mainly emits pulses to act around the nerve tissue through the radiofrequency instrument and creates a high voltage so that the heat generated by the pulse current near the affected tissue can be diffused. The local temperature does not exceed 42 °C, avoiding the damage caused by high temperature to the nerve, and the nerve tissue does not degenerate and can play a protective role in integrating nerve functions to avoid postoperative sensory and motor nerve abnormalities caused by nerve injury [18,19]. Kagan et al [20] reported that the ultrastructural assessment of PRF lesions in rat lower extremity nerve showed that PRF treatment did not cause the unmyelinated nerve fibers to ultrastructurally impair.…”