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KMID : 1150120160020010029
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Asian Journal of Pain
2016 Volume.2 No. 1 p.29 ~ p.33
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Usefulness of Nerve Blocks and Radiofrequency Treatment in Nonagenarians with Chronic Radicular and Low Back Pain : A Preliminary Study
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Yoon Sang-In
Kim Tae-Shin
Lee Jang-Bo
Park Jung-Yul
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Abstract
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Objective: The purpose of this study is to evaluate the usefulness of minimal invasive interventional treatments with series of nerve blocks and radiofrequency (RF) treatment on dorsal root ganglion(s) and medial branches in patients aged 90 years and older who suffered from chronic radicular and back pain.
Methods: A total of 10 consecutive patients who were treated conservatively within recent one year period were included in this study. All patients were over 90 years of age with chronic low back and radicular pain, without major neurological deficits, for more than six months that were refractory to medication and rehabilitation treatment. All patients had combination of various pathologies including multiple spinal stenosis, herniated discs, and facet arthropathies. Treatments comprised of series of nerve block (medial branch blocks) with or without radiofrequency lesionings (RF neurotomy on medial branch and pulsed RF dorsal root ganglionotomy). Those who had recurrent pain after two nerve blocks which showed more than 50% pain relief for at least 2 weeks following two nerve blocks also received RF treatment. Follow up period was at least six months after treatments.
Results: There were 4 patients who received nerve blocks only and 6 patients who also received RF treatment. Average baseline pain severity was 6.7 (range 4?9). Six months after the procedures in patients who received both nerve blocks and RF treatment, 1 patient showed excellent (>75% reduction of baseline pain), 3 patients reported good (>50%) results, and remaining 2 patients showed moderate response (>30%). There were no patients with poor (<30%) or no response and no complications from the procedures except moderate pain following the RF procedures in 4 patients that persisted for average of 4.7 days. All patients are functionally stable at last follow up period.
Conclusion: Series of nerve blocks with or without RF treatment seem to provide substantial pain relief with satisfaction even in very old patients with chronic low back pain and radicular pain from various mixed pathologies. Although longer term follow up with more patients is warranted in future study, it can thus be considered as safe and effective treatment option before selecting surgery with a reasonable tradeoff in terms of pain reduction and functional disability improvement.
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KEYWORD
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Nonagenarians, Nerve block, Radiofrequency, Lesioning, Mechanical back pain
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