A Combination of Pulsed Radiofrequency Application to Dorsal Root Ganglia and Transforaminal Injection of Autologous Platelet Lysate for Management of Failed Back Surgery Radicular Pain: A Prospective Study

Background: Lumbosacral radiculopathy is often found in people who have back pain.

Objective: This study used a combination of autologous platelet lysate injection and applied pulsed radiofrequency (PRF) to the dorsal root ganglion to treat lumbosacral radicular pain of patients with failed back surgery syndrome.

Methods: This was a prospective study with only one arm. People with failed back surgery radicular pain who were sent to Zanko Private Hospital in Erbil, Iraq, took part. The 22G × 4 inch radiofrequency probe tip was brought close to the dorsal root ganglion with the help of a fluoroscope. A temperature of 42°C was used to treat the patients with PRF for 300 seconds.

The venous blood sample (60 mg) was centrifuged (200g) for ten minutes and the supernatant was removed. After freezing at -80°C and defrosting, the samples were centrifuged again and the supernatant was collected. Platelet lysate injection was performed after complete PRF and in the same place under the fluoroscopy guide.

Results: A total of 15 patients with lumbosacral radiculopathy with an average age of 51.06 ± 15.3 years were included in this study; 6 were men (40%) and 9 were women (60%). The most common nerve roots involved were L4 and L5 (93.3%), L3 (66.7%), and S1 (40%), respectively. The side of radiculopathy was right in 40% of cases, bilateral in 33.3%, and left in 26.7%. The average NRS pain score before the interventions was 6.13±1.06, which reached 6.06±1.27 in the second week after the interventions. According to the results of the paired t-test, there was no statistically significant decrease in the pain score (P=0.865). However, 10 weeks after the intervention, the mean NRS pain score was reported as 2.93 ± 1.16, which was significantly lower than the pain reported before the intervention and 2 weeks after the intervention (P<0.001). A reduction of more than 50% in the NRS score was observed in no patient during 2 weeks after the intervention and in 11 patients (73.3%) after 10 weeks of the intervention.

Conclusion: In patients with lumbosacral radiculopathy due to failed back surgery syndrome, applying PRF to the dorsal root ganglion along with transforaminal injection of autologous platelet lysate can significantly reduce the patient's pain, at least in the mid-term.