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Related Concept Videos

Herniated Intervertebral Disc l: Introduction01:29

Herniated Intervertebral Disc l: Introduction

Intervertebral disc herniation refers to the displacement of the nucleus pulposus (the gel-like inner core of the disc) through a tear or weakened area in the annulus fibrosus (the outer fibrous ring). The displaced disc material extends beyond the normal boundaries of the disc space and may compress or irritate nearby spinal nerve roots or, less commonly, the spinal cord.Etiology and Risk FactorsHerniation commonly results from degeneration, in which aging reduces disc hydration and...

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CT-guided Pulsed Radiofrequency Combined with Steroid Injection for Sciatica from Herniated Disk: A Randomized Trial.

Alessandro Napoli1, Giulia Alfieri1, Alessandro De Maio1

  • 1From the Department of Radiological, Oncological, and Pathological Sciences, Policlinico Umberto I-Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P., C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N., E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.); Department of Radiology, Stanford University, Stanford, Calif (P.G.); and Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.J.S.).

Radiology
|March 28, 2023
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Summary

Combined pulsed radiofrequency (PRF) and transforaminal epidural steroid injection (TFESI) significantly improved sciatic pain and disability compared to TFESI alone. This combined treatment offers a more effective nonsurgical option for lumbar disk herniation-related sciatica.

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Area of Science:

  • Interventional Pain Management
  • Neurosurgery
  • Radiology

Background:

  • Limited evidence exists for effective nonsurgical management of sciatica.
  • Sciatica, often caused by lumbar disk herniation, presents a significant clinical challenge.
  • Conservative treatments may not always provide adequate relief for persistent sciatic pain.

Purpose of the Study:

  • To compare the effectiveness of combined pulsed radiofrequency (PRF) and transforaminal epidural steroid injection (TFESI) versus TFESI alone for sciatica.
  • To evaluate the impact of these treatments on leg pain severity and functional disability.
  • To provide evidence for optimizing nonsurgical sciatica management.

Main Methods:

  • A prospective, multicenter, double-blind, randomized clinical trial.
  • 351 participants with chronic sciatica due to lumbar disk herniation were randomized to receive either combined PRF and TFESI (n=174) or TFESI alone (n=177).
  • Primary outcome: leg pain (Numeric Rating Scale); Secondary outcomes: disability (Roland-Morris Disability Questionnaire, Oswestry Disability Index).

Main Results:

  • The combined PRF and TFESI group showed significantly greater reductions in leg pain at weeks 1 and 52 compared to the TFESI alone group (P < .001).
  • At week 52, the combined treatment group demonstrated significantly better outcomes for both Oswestry Disability Index (P < .001) and Roland-Morris Disability Questionnaire (P < .001) scores.
  • Adverse events were infrequent and mild, with no severe events reported in either group.

Conclusions:

  • Combined PRF and TFESI is a more effective nonsurgical treatment for sciatica caused by lumbar disk herniation than TFESI alone.
  • This combination therapy leads to superior pain relief and functional improvement in patients with sciatica.
  • The findings support the use of combined PRF and TFESI for managing refractory sciatic pain.