Pain relief clinical efficacy using pulsed radiofrequency ablation of nerve roots in patients with spine metastatic lesions. A prospective study

Aim. The objective of the study is to evaluate the clinical efficacy and safety of PRFA (pulsed radiofrequency ablation) of nerve roots in improving general somatic and functional status (Karnofsky score), decreasing pain (NRS) and reducing analgesics consumption (Watkins score) in patients with spine metastatic lesions. Materials and methods. This study involved the analysis of 230 patients with pain syndrome related to metastatic lesions in the spine. Those patients were divided into two groups. The first group included 156 patients who underwent Pulsed RFA of nerve roots in order to relieve pain. There were 69 men and 87 women. The second group, which received only drug treatment with non-opioid and opioid analgesics, consisted of 74 patients, including 30 men and 44 women. The performance status was evaluated with the Karnofsky score (%), pain degree was assessed with the Numerical Rating Scale from 0 to 10 (NRS), and analgesics consumption reduction was assessed by the Watkins scale. Overall treatment satisfaction in patients and physicians was evaluated with the Likert scale. Results. In the pulsed RFA group, 124 (79.5%) patients out of 156 had effective therapy in the form of NRS decrease of at least 50% and at least 1 point decrease by the Watkins scale. The performance status improved by at least 10% according to the Karnofsky index in 121 (77.6%) patients. As for the control group, the effectiveness of pharmacotherapy based on NRS was achieved in 65 (87.8%) out of 74 patients, and the general somatic status was improved in 60 (81.1%) patients. The maximum analgesic effect of the nerve root RFA is achieved on the 10th day after the procedure, maintaining for up to 90 days without dynamics. The level of statistical significance was p0.001. In the RFA group, 153 (98.01%) patients experienced no complications, and in the control group, complications were seen in 64 (86.5%) cases, manifested themselves in the form of adverse events from analgesics used for pain control. Originally, prior to the study, all 100% of patients in both groups expressed pain therapy dissatisfaction before consulting a vertebrologist. The unsatisfactory score proportion on the Likert scale during the treatment in the RFA group decreased to 20.5% (32), and in the pharmacotherapy group – to 28.4% (21), respectively. Conclusion. Pulsed radiofrequency ablation of nerve roots is highly effective and safe, minimally invasive neuromodulatory method for pain treatment in cancer patients with nerve roots compression caused by the spine metastases. This method allows within a short period to reduce or decrease the severity of pain syndrome in 79.5% of patients, contributing to their physical activity increase and improving the quality of life in 77.6% of patients. Pulsed RFA of nerve roots has advantages over conservative treatment in various aspects: decrease in pain syndrome intensity, enhanced patients satisfaction with treatment results, significant pharmacological stress and its associated complications reduction, improved patients physi-cal activity and quality of life.