Researchers from Sapienza University of Rome have demonstrated that CT-guided pulsed radiofrequency (pRF) provides a safe and effective treatment for acute lower back pain that doesn’t respond to conservative therapy. The minimally invasive procedure involves applying pulses of energy directly to the portion of the nerve responsible for sending pain signals.

“Pulsed radiofrequency creates a nerve modulation, significantly reducing inflammation and its associated symptoms,” said senior author Alessandro Napoli, who presented the study today at the RSNA annual meeting.

Lumbar disk herniation is a common, often debilitating, condition that affects the disks between the vertebrae of the lower spine. Herniation occurs where the gel-like material in the centre of the disk bulges through a tear in the disk’s exterior and puts pressure on the roots of the nerves. Conservative treatment options range from over-the-counter pain medications to injections of corticosteroids into the affected area of the spine. Non-responders may require surgery and, in some cases, the entire disk must be removed and the vertebra fused together for stability.

Napoli and colleagues studied the use of pRF in patients with back pain from lumbar disk herniation that had not responded to prolonged treatment. In 128 patients, they delivered pRF under CT guidance directly to the root of the symptomatic nerve, for 10 minutes. For comparison, 120 patients received one to three sessions of CT-guided steroid injection on the same anatomical target with no pRF.

The one-year outcomes demonstrated that CT-guided pRF was superior to the injection-only strategy. Patients who received pRF saw greater overall improvement in pain and disability scores during the first year. Relief of leg pain was faster in patients assigned to pRF, and they also reported a faster rate of perceived recovery. The probability of perceived recovery after one year of follow-up was 95% in the pRF group, compared with 61% in the injection only group. Six patients were considered partial responders and required a second PRF session.

“Given our study results, we offer pulsed radiofrequency to patients with herniated disk and sciatic nerve compression whose symptoms do not benefit from conservative therapy,” says Napoli. “Of the different therapies available, pulsed radiofrequency is among the least invasive. Treatment lasts 10 minutes, and one session was enough in a large number of treated patients.”

The use of pRF may help many patients with sciatic disk compression avoid surgery. It could improve outcomes for patients set to receive corticosteroid injections. “We learned that when pulsed radiofrequency is followed by steroid injection, the result is longer lasting and more efficacious than injection only,” Napoli explains. “The effect of pulsed radiofrequency is fast and without adverse events.”