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Correspondence  |   April 2005
A Safer and More Effective Intervention for Radiculopathic Pain
Author Affiliations & Notes
  • Dan C. Martin, M.D.
    *
  • * Medical College of Georgia, Augusta, Georgia.
Article Information
Correspondence
Correspondence   |   April 2005
A Safer and More Effective Intervention for Radiculopathic Pain
Anesthesiology 4 2005, Vol.102, 869. doi:
Anesthesiology 4 2005, Vol.102, 869. doi:
To the Editor:—
We thank Dr. Rathmell et al.  for emphasizing the potential hazards of transforaminal injections.1 It is clear that these injections should be performed by individuals who are fully trained in advanced imaging and interventional techniques. Moreover, the practitioner must be capable of managing any adverse sequelae.
Although the treatment of radiculopathic pain with the local injection of corticosteroid is appreciated, we believe that the best treatment of radiculopathic pain is by the application of pulsed radiofrequency current to the involved dorsal root ganglion. In our extensive experience with pulsed radiofrequency, we have found the results of treatment to be superior to those of conventional corticosteroid injections in both effectiveness and duration.2,3 Furthermore, pulsed radiofrequency application exposes patients to less risk for the following reasons: (1) Cannula placement can be performed based solely on osseous anatomy and electrophysiologic stimulation results. Therefore, no injection of any material is requisite. (2) The patient is exposed to no systemic sequelae of medication or radiocontrast administration. (3) Unlike injection therapies, pulsed radiofrequency can be repeated as indicated, without fear of accumulating medicinal toxicity.
The only potential disadvantage to the use of pulsed radiofrequency versus  injection therapy is the requirement of a larger cannula (20–22 vs.  26 gauge) that could cause more tissue trauma. Regardless, the take-home message is well elucidated by the authors. Spinal interventional techniques should only be performed by practitioners who have demonstrated expertise in neuraxial imaging for interventional treatment modalities.
* Medical College of Georgia, Augusta, Georgia.
References
Rathmell JP, Aprill C, Bogduk N: Cervical transforaminal injection of steroids. Anesthesiology 2004; 100:1595–600Rathmell, JP Aprill, C Bogduk, N
Sluijter ME, Cosman ER, Rittman WB, Van Kleef M: The effects of pulsed radiofrequency fields applied to dorsal root ganglion: A preliminary report. Pain Clin 1998; 2:109–17Sluijter, ME Cosman, ER Rittman, WB Van Kleef, M
Mikeladze G, Espinal R, Finnegan R, Routon J, Martin D: Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain. Spine J 2003; 3:360–2Mikeladze, G Espinal, R Finnegan, R Routon, J Martin, D