Radiofrequency Treatment Adjacent to the Cervical Dorsal Root Ganglion

Cervical radicular pain is pain perceived in the arm, shooting or electric in quality, caused by irritation or injury of a cervical spinal nerve root. It affects approximately 1 in 1000 adults annually. When cervical radicular pain does not resolve spontaneously within 3 months, serious underlying pathologies, such as infection and cancer, should be excluded before offering further symptomatic treatment. The neurological examination includes sensory, motor, and reflex evaluation. The clinical tests: neck compression test or Spurling test, shoulder abduction test, Valsalva maneuver, axial traction test, and Elvey’s upper limb tension test have a high specificity but a low sensitivity. The determination of the symptomatic level is done with diagnostic selective nerve root blocks. The prognostic block is performed by injecting a radio-opaque mixture of iohexol and lidocaine around the nerve. The block is considered positive when it results in minimum 50% pain reduction, measured on the visual analogue scale within 30 min. Radiofrequency treatment applies high frequency current adjacent to the dorsal root ganglion. The aim is to increase the electrode tip temperature to 67°C. This temperature is maintained during 60s. The pulsed radiofrequency current is applied in small bursts at 45 V and the temperature is kept below 42°C. There is evidence from two randomized controlled trials that radiofrequency treatment could be used for the treatment of cervical radicular pain. The outcome of pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is supported by observational studies and a randomized controlled trial. There a few side effects with radiofrequency treatment and when they occur, they are usually minor and transient. Deafferentation pain is rarely occurring with conventional radiofrequency. No side effects and complications of pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion have been reported.