​Introduction:
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For a long time, all we had to offer to the patients who suffer from severe pain in the pathway of a nerve root was limited to epidural injection. 

The approaches of performing epidural injection of corticosteroid have changed significantly and over the time, the efficacy and duration of action have increased. As well the safety and precision of the procedure has increased by using the x-ray as the guidance. 

Unfortunately after all those changes, a small group of patients never felt enough relief to justify performing the procedure a few times a year. To understand the reasons behind the different responses, one needs to understand the rationale of using corticosteroid medication in the epidural space.

As a general rule, any time the part of our body exposes to a trauma, the response includes some edema at the site of trauma. If you experience a trauma to the end of one of your fingers, the first change you would notice in the first hour, would be swelling of the tissues. Now think about the situation that a "ring" on that finger does not allow enough of swelling. The end results would increase the pressure "inside" your finger, between the bone and the ring.

The same scenario happens in the exit of the nerve roots from the spinal column. The neuroforamina, or the bony structure around the nerve root, plays the role of the "ring around the finger". By injecting corticosteroid, we aim to reduce the edema and swelling and therefore, reduce the pressure on the nerve root.

DRG

Definition:

radiofrequency (RF) dorsal root ganglion (DRG) lesion (RF-DRG) is a procedure in which a radiofrequency electrode is placed in the vicinity of the dorsal root ganglion of a spinal nerve, and a radiofrequency current is passed through the electrode, for the purpose of creating a lesion in the nerve of sufficient magnitude sufficient to relieve pain, but without actually damaging the nerve (seeRadiofrequency Neurotomy, Electrophysiolog​ical Principles).

Skill required

To perform the radiofrequency procedure safely, we needed to invest a long time learning about different characteristic and therapeutic options in the radiofrequency machine.  In the last 8 years, I had the opportunity to use different radiofrequency machines and get familiar with the feature and therapeutic value of each option.  As well as a part of a large group of interventional pain management anesthesiologist in North America and Europe, we all learn how to perform the most efficient radiofrequency treatment for the dorsal root ganglion.

who is the candidate?

The ideal candidate to perform radiofrequency procedure of dorsal root ganglion or:
  • Radiculopathy in one or 2 nerve roots toward the leg
  • Radiculopathy in the lower abdominal area
  • Pain after Shingles in the lower part of the body