Dorsal Root Ganglion Block and Pulsed Radiofrequency
The anatomy of Dorsal Root Ganglion
The dorsal root, also known as the posterior root of the spinal nerve, is one of two roots which come directly out of the spinal cord. It is connected to the dorsal root ganglion and combines with the ventral root to form a spinal nerve which supplies a specific part of the body.
The dorsal root ganglion (DRG) has been found by research to be active in the development of neuropathic pain. Neuropathic pain can be caused by a wide variety of conditions, including chronic post surgical pain, nerve compression, which is the result of a herniated disc or arthritis in the spine, and spine surgery. Dorsal Root Ganglion block is a treatment which addresses radicular pain, also known as sciatica, in the lower limb and other causes of neuropathic pain.
Targeted numbing of the Dorsal Root Ganglion disrupts pain signals for a variable period. It can be used to both diagnose and treat the symptoms. Pulsed Radiofrequency neurotomy to prolong the benefit may be indicated if there is a significant reduction in the pain levels after the block. Pulsed radiofrequency of the dorsal root is undergone in order to modulate the function of the nerve using electrical stimulation, thus providing pain relief.
Pulsed radiofrequency of dorsal root ganglion is a relatively new type of neurostimulation therapy which can address neuropathic pain which has proven difficult to treat, including in the upper and lower limbs, hip, groin and hands. The procedure aims to target and then relieve focal pain by stimulating the dorsal root ganglion. It enables pain relief by targeting the dorsal root ganglion structures of dense nerves along the spinal column – these structures correspond to other areas of the body mentioned above – such as the upper and lower limbs, hip, groin and hands.
Using pulsed radiofrequency of dorsal root ganglion, pain signals to the brain are interrupted with an electrical pulse, meaning the patient does not feel the same pain as he or she did previously.
Dorsal root ganglion block and Pulsed Radiofrequency procedure
Dorsal root ganglion block and Pulsed Radiofrequency are day case procedures typically performed using fluoroscopy (live X-ray) to help guide the needle accurately and avoid any nerve injury.The procedure will take place in theatre under full aseptic conditions with the patient on his or her stomach. A small needle in the back of your hand can be used to administer sedation or in case of an emergency. The skin is well cleaned before a small amount of local anaesthetic is applied in order to numb the injection area. The physician then directs a small needle into the Dorsal Root Ganglion, injects contrast dye to confirm the correct location and administers al mixture of steroid (anti-inflammatory medication) and anaesthetic.
To prolong the benefit, Pulsed Radiofrequency neurotomy may be indicated if there is a significant reduction in the pain levels after the block. On a separate admission, the treatment involves a generator which after precision and safety tests sends out measured electrical pulses using thin insulated wires to the dorsal root ganglia. This procedure can be described as a ‘retuning’ of the nerves so they modulate pain transmission.
Patients are then monitored in a recovery area before transfer to the ward and discharge home. Patients may experience a numb feeling for a few hours. Pain at the injection site may increase for seven or more days. It is advisable to rest for 24 hours and resume stretches and exercises when the pain eases. This window of pain relief should be utilised for performance of strengthening exercises and rehabilitation physiotherapy.
There is a variable response to injection treatment. It is important to discuss both the benefits and risks of the procedure with your doctor before any agreement to undergo the procedure is reached. There is a variable response to injection treatment. Although the chance of any complications is generally low, as with all surgical procedures, there is an element of risk involved including failure to get benefit or pain aggravation. There may be an allergic reaction to the steroid or any of the medications, or that the injection causes an infection or bleeding. Paralysis, spinal cord or nerve damage is extremely rare.