الفهرس 
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Abstract
Lumbar-radicular pain is defined as a pain that radiates from back into the lower extremity along the course of a spinal nerve root. The most common cause of radicular pain is disc herniation, that is diagnosed clinically and radiologically using MRI. Conservative treatment (pharmacotherapy or physiotherapy) is effective management in 2/3 of patients, yet pain continues to be chronic in the remaining cases and affects patient physically and psychologically.
Many minimally invasive interventions are tried for chronic radicular pain due to disc herniation, including nerve root or epidural injection, endoscopic discectomy, spinal cord or DRG stimulation and modulation.
Dorsal root ganglions (DRGs) ablation or stimulation is a novel therapeutic option for chronic radicular pain. DRGs are 31 pairs, convey all sensory information including pain from the periphery to the spinal cord. Mechanical compression or irritation to DRGs liberates pain mediators and initiates ectopic firing that once transmitted to spinal cord induces central sensitization, therefore DRGs have become an important target area for treating radicular pain.
DRGs have different locations and sizes along vertebral column. In lumbar region, the sizes of the DRGs increase progressively from L1 to a maximum at L5, and the distribution is either foraminal or extra foraminal. Morphologically, DRG may be singular, biganglia or triganglia.
Pulsed radiofrequency (PRF) is the technique commonly used for neural modulation of dorsal root ganglions (DRGs). PRF generates a radiofrequency current in short, high-voltage bursts with intermission for enough heat dissipation time to ensure temperature not higher than 42-C. Thus it suppresses the action potential transmission by neurons with no neural damage.
Fluoroscopic guidance is an imaging guide that is strongly recommended in interventional spine procedures including PRF modulation of DRGs. Radiation exposure is the major health hazard associated with performing fluoroscopic images.
Growing interest of US guided intervention techniques in chronic pain encourages its use in spine region. The advantages of using ultrasound over other radiological modalities are; no ionizing radiation hazards, better visualization of soft tissues (i.e., muscle, ligament) and blood vessels, and a real time visualization of needle advancement. It is portable, and is cost effective. However, several concerns such as accuracy and precision, reliability and patient safety should be addressed.
Patients who may benefit from image-guided interventions for lower back pain are those who have had symptoms for at least 6 weeks with inadequate response to conservative treatment measures such as physical therapy, exercise therapy, heat therapy, massage therapy, anti-inflammatory or antispasmodic medications, and/or narcotic analgesics. Patients who are significantly debilitated or unable to fully participate in physical therapy and rehabilitation due to limitations posed by pain should also be considered for intervention.
A primary goal in the management of chronic low back pain may be temporary alleviation of pain to enable the patient to become fully engaged in a physical therapy and rehabilitation program aimed at improving strength and body mechanics to minimize physical stress and provide more long-term relief.
Aim of the work:
The primary outcome of the present study was pain relief. The secondary outcomes were to measure the grade of accuracy of US guided transforaminal PR cannula placement adjacent to the desired DRG, analgesic consumption ,patients’ functionality and safety of the technique.
Patients and methods:
The study was conducted on 32 patients complaining of chronic radicular pain, referred to the interventional radiology unit in the Radiodiagnosis Department at Alexandria Main University Hospital and Pain Management Unit at the Medical Research Institute, Alexandria university.
Results:
30 patients received unilateral interventions and 2 patients received L4 and L5 bilateral interventions with a total of 34 interventional procedures.
The VAS of radicular pain decreased significantly at 2 week, 4 week and 3 months in comparison to the pre-operative intervention VAS value.
The overall accuracy of US guided FL verified DRG pulsed radiofrequency modulation was 91.18.
The time taken for successful first trial RF cannula placement under US guidance was significantly shorter than the time consumed for more than one trial.
Patients reported severe to moderate disability index at pre intervention time with a mean = 41.44±14.33, this index decreased significantly at post intervention time with mean of 12.19±10.40 at 2 weeks, 11.25±9.46 at 4 weeks and 10.50±8.96 at 3 months.
Regarding analgesic consumption reduction, Complete cessation was achieved in 53.1% of patients, decrease to half dose in 40.6% of patients and no reduction in analgesic consumption in only 6.25 % of patients.
The complications were minimal after intervention 5 patients out of the 32 reported brief tenderness at site of injections that continued for 3to 7 days, Ten patients out of the 32 patients experienced transient sensory changes in the ipsilateral leg which resolved in one week.