1. Percutaneous Pulsed Radiofrequency in the Treatment
of Cervical and Lumbar Radicular Pain
Experiences of 154 Patients
經皮脈衝高頻療法治療頸腰椎神經根疼痛—一百五十四個病人的經驗
趙紹清醫師,鄒錫凱醫師,沈炯祺主任
台中榮民總醫院神經外科
各位大家好,我是台中榮總神經外科住院醫師趙紹清,今天要為大家報告的是本科針對頸腰椎神經根疼痛的病人施以脈衝高頻療法的經驗

2. Introduction of Pulsed RF
Precise anatomic locations
Brief “pulses” of high-voltage, radiofrequency range electrical current
Not to produce a heat lesion above 45°C
Produce analgesia without producing destruction of nerves
Pain relief caused by cellular changes induced by magnetic fields, not tissue destruction by heat
Neuromodulation, not neuroablation
Success in reducing a number of different chronic pain states in past ten years
相信在座各位對於脈衝高頻療法都有一定程度的了解,它需要在精確的解剖位置,施以高壓高頻的電流,加熱位置不超過45度C,在以不傷害到神經的狀況下,達到止痛的效果,經研究證實,其止痛效果是由於電流產生的磁場所造成的細胞變化來產生的,而不是由高熱所破壞組織來造成的,簡而言之,它是一種neuromodulation,在過去十年間,有研究報告來討論其對於不同慢性疼痛有成功的療效

3. Reports on Midline
Munglani R. The longer term effect of pulsed radiofrequency for neuropathic pain. Pain 1999;80:437–9.
Van Zundert J, Brabant S, Van de Kelft E, Vercruyssen A, Van Buyten JP. Pulsed radiofrequency treatment of the Gasserian ganglion in patients with idiopathic trigeminal neuralgia. Pain 2003;104(3): 449–52.
Van Zundert J. , Percutaneous Pulsed Radiofrequency Treatment of the Cervical Dorsal Root Ganglion in the Treatment of Chronic Cervical Pain Syndromes: A Clinical Audit, Neuromodulation, Volume 6, Number 1, –14
Geurts JW, van Wijk RM, Wynne HJ, Hammink E, Buskens E, Lousberg R, et al. Radiofrequency lesioning of dorsal root ganglia for chronic lumbosacral radicular pain: a randomised, doubleblind, controlled trial. Lancet 2003;361(9351):21–6.
Mikeladze G, Espinal R, Finnegan R, Routon J, Martin D: Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain. Spine J 2003; 3:360–2
Cohen SP, Foster A. Pulsed radiofrequency as a treatment for groin pain and orchialgia. Urology 2003;61:45.
Sluijter ME. The role of radiofrequency in failed back surgery patients. Curr Rev Pain 2000;4:49–53.
Shah RV, Racz GB. Long-term relief of posttraumatic headache by sphenopalatine ganglion pulsed radiofrequency lesioning: a case report. Arch Phys Med Rehabil 2004;85(6):1013–6.
Teixeira A, Grandinson M, Sluijter ME. Pulsed Radiofrequency for Radicular Pain Due to a Herniated Intervertebral Disc—An Initial Report, Pain Practice, Volume 5, Issue 2, –115
如腫瘤壓迫的神經痛,三叉神經痛,慢性的頸腰椎疼痛,難以控制的鼠膝部疼痛及睪丸痛,腰椎術後的疼痛,外傷後頭痛以及神經根壓迫的疼痛等皆有研究報告來討論其成效

4. Reports on Midline
This is a retrospective analysis on 114 Patients with a chief complaint of axial cervical or lumbar pain and who denied radicular symptoms were treated with PRF. In 68 (68/114, 59.6%) patients, the procedure was successful (pain reduction more than 50%) and lasted on average 3.93 ±1.86 months.
Mikeladze G, Espinal R, Pulsed radiofrequency application in treatment
of chronic zygapophyseal joint pain. Spine J 2003; 3:360–2
This paper reports the results of a clinical audit of the first consecutive 18 patients with intractable cervicobrachialgia and who were treated with PRF of the cervical dorsal root ganglion. Satisfactory pain relief of at least 50% was achieved in 13 of 18 (72%) patients at post-operation 8 weeks. More than one year after treatment, 6 patients (33%) continue to rate treatment outcome as good or very good.
Van Zundert J. , Percutaneous Pulsed Radiofrequency Treatment of the Cervical
Dorsal Root Ganglion in the Treatment of Chronic Cervical Pain Syndromes:
A Clinical Audit, Neuromodulation, Volume 6, Number 1, –14
我們針對頸腰部疼痛的病人施以脈衝高頻療法的效果來 review Midline上的文章,這篇出自2003年的spine,對於有頸腰部疼痛超過6個月而且沒有神經根症狀的114位病人來施以脈衝高頻療法,有59.6%的病人獲得一半以上的疼痛改善且平均持續約4個月;這篇是出自2003年 neuromodulation,對於有cervicobrachialgia的18位病人來施以脈衝高頻療法,術後八週後有72%的病人獲得一半以上的疼痛改善,而治療一年後還有33%的病人有 一半以上的疼痛改善.

5. Reports on Midline
This is a retrospective study on 13 consecutive patients with radicular pain, due to a herniated intervertebral disc, at levels L3 to S1.All were treated with PRF of lumbar dorsal root ganglion. The numeric rating scale (NRS) score fell from 7.83 to 2.25 over the first 2 weeks.
Teixeira A , Pulsed Radiofrequency for Radicular Pain Due to a Herniated Intervertebral
Disc —An Initial Report, Pain Practice, Volume 5, Issue 2, –115
This study reports the result of pulsed RF in 28 patients suffering from severe radicular pain treated by pulsed RF .There were 20 cases of low back pain and 8 with neck pain. The first follow-up after 3 months revealed the following results: excellent results in 2 cases (7.1%), good results in 12 cases (42.9%), fair in 9 (32.1%) and unresponsiveness to treatment in 5 (17.9%). Significant reduction was found in the Visual Analog Scale for pain from an average of 8.8 to 4.2 after 3 months, 4.8 after 6 months and 4.9 after 1 year.
Pevzner E; David R; Leitner Y, Pulsed radiofrequency treatment of severe
radicular pain, Harefuah, 2005 Mar; Vol. 144 (3), pp , 231.
這篇是出自2005年pain practice,對於13位因腰椎椎間盤突出造成的神經根疼痛來施以脈衝高頻療法,其NRS score 從術前7.83掉到術後兩週後的2.25;而這篇是出自2005年 Harefuah,針對28位頸腰椎神經根疼痛的病人施以脈衝高頻療法,術後3個月,有7.1%進步75%以上,有42.9%進步75到50%以上,而visual analog score從術前的8.8掉到4.2.

6. Patient selection
We collected 154 cases with a chief complaint of cervical or lumbar radicular pain due to a herniated intervertebral disc or previous failed surgery, from September 2004 to October 2005
Follow-up period was from one week to one year postoperatively.
There are 71 male and 83 female patients.
The mean preoperative visual analog pain scale of patients who had cervical, lumbar radicular pain were 67.55±14.37, 65.52±16.44 (0-100).
台中榮總從2004年9月到2005年10月收集154位因椎間盤突出或先前手術失敗而造成頸腰椎神經根疼痛的病人施以脈衝高頻療法,追蹤時間由術後一週到一年,71位是男性,83位是女性,而術前的visual analog pain scale頸椎的是67.55,腰椎的是65.52

7. Table 1. The demographic and clinical features of 154 patients
Cervical
(N=49)
Lumbar
(N=116)
Total
(N=165)
Male [range]
17 [32-76]
58 [26-92] 75
Female [range]
32 [39-79]
58 [31-88] 90
Age (years, mean ± SD)
53.20 ± 10.99
62.42 ± 13.16
Visual analog pain scale
(0-100, mean ± SD)
67.55 ± 14.37
65.52 ± 16.44
這是154位病人的相關資料,在154位病人中,其中有6人是做了頸椎又做了腰椎手術,而有3位做了兩次頸椎手術,有2位做了兩次腰椎手術,所以總手術次數為165次,頸椎49次,腰椎116次,而平均年齡頸椎為53.20歲,腰椎為62.42歲

8. Table 2. The treatment levels and disease classification
Cervical (n=49)
Lumbar (n=116)
Nerve roots
(C3) 3
(L3) 18
(C4) 40
(L4) 95
(C5) 49
(L5) 112
(C6) 30
(S1) 19
(C7) 2
Disease classification
Cervical HIVD with radiculopathy 44
Previous failed cervical surgery 5
Lumbar HIVD with radiculopathy 88
Failed back surgery syndrome 28
Treatment side
R’t. 29 66
L’t. 20 50
而頸椎有44位是因椎間盤突出造成的,5位是因先前手術失敗造成的,治療的level以C4C5最多,右側比左側稍多,腰椎有88位是因椎間盤突出造成的,28位是因先前手術失敗造成的,治療的level以L4L5最多,右側比左側稍多,

9. Table 3. Results after cervical pulsed radiofrequency stimulation
*The improvement was defined as patient who has the pain relief> 0; The satisfaction was defined as patient who has the pain relief≧ 50%
1 week (N=49)
1 month (N=49)
3 months (N=49)
6 months (N=40)
9 months (N=21)
1 year (N=7)
worse 0% 10 14 15 7 3
0<&<50% 13 9 8 2
50<=&<100 24 22 19
100% 4 1
Improvement rate (%)*
79.59
71.43
62.50
66.67
57.14
Satisfactory rate (%)*
53.06
61.22
55.10
55.00
本表為頸椎施以脈衝高頻療法的結果,satisfaction是疼痛減輕一半以上,improvement是疼痛有進步就算,而術後一週到一年,滿意度的比率都超過五成,以術後一個月61.22最高

10. Figure 1.
這是把上張表格轉成數據,黑色部分是沒有改善的比例,隨著時間的增加,漸漸的往上升,但還在四成以下,且沒有病人變的更差或有併發症

11. Figure 2. Visual analog pain scale distribution on cervical patients with improvement ≧ 50% and last for more than 1 month
這張表格是針對頸椎病人進行脈衝高頻療法visual analog pain scale的曲線圖,術前60幾,術後一個月到最低點,之後慢慢升高,但幅度不大

12. Table 4. Results after lumbar pulsed radiofrequency stimulation
*The improvement was defined as patient who has the pain relief> 0; The satisfaction was defined as patient who has the pain relief≧ 50%
1 week (N=116)
1 month (N=116)
3 months (N=116)
6 months (N=108)
9 months (N=58)
1 year (N=43)
worse 0% 21 26 34 48 28 20
0<&<50% 36 30 17 14 13
50<=&<100 51 44 39 32 11 7
100% 8 12 5 3
Improvement rate (%)*
81.90
77.59
70.69
55.56
51.72
53.49
Satisfactory rate (%)*
50.86
48.28
44.83
39.81
27.59
23.26
這張表格是腰椎進行脈衝高頻療法,滿意度以術後一周50.86最低,之後隨著時間遞減,六個月內滿意度約可維持4成以上

13. Figure 3.
這是把上張表格轉成數據,黑色部分是沒有改善的比例,隨著時間的增加,漸漸的往上升,但還在四成以下,沒有病人變的更差或有併發症

14. Figure 4. Visual analog pain scale distribution on lumbar patients with improvement ≧ 50% and last for more than 1 month
這張表格是針對腰椎病人進行脈衝高頻療法的visual analog pain scale的曲線圖,術前60幾,術後一個月到最低點,之後慢慢升高,但幅度不大

15. Results
30 in 49 numbers (61.22%) and 56 in 116 numbers (48.28%) after cervical, and lumbar pulse radiofrequency stimulation had the initial improvement ≥ 50% in the first month follow up.
22 in 40 numbers (55.00%) and 43 in 108 numbers (39.81%) after cervical and lumbar pulse radiofrequency stimulation had pain relief ≥ 50% at the follow-up period of six months.
After one year follow up, 4 in 7 numbers (57.14%) and 10 in 43 numbers (23.26%) after cervical and lumbar pulse radiofrequency stimulation had the pain relief effect ≥ 50%.
最後結果做個總結,術後一月後頸部的滿意度為61.22%,腰椎的是48.28%,而術後三個月頸椎為55.10%,腰椎為44.83%,最後到術後一年,頸椎還有57.14%,腰椎還有23.26%

16. Conclusion
The results of this retrospective analysis showed that the application of pulsed radiofrequency is a safe and useful intervention for cervical and lumbar radicular pain (approximately one year).
Although pulsed radiofrequency appears to provide intermediate-term relief of pain, further studies with long-term follow-up are necessary.
結論就是脈衝高頻療法是一個安全沒有副作用而且治療效果良好的輔助性療法,可以提供短中期的疼痛舒緩,但對於壓迫神經根嚴重的病人,還是要尋求減壓手術的治療

17. Thank you for your attention