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Bilateral L2 DRG pRF for discogenic pain

Discussion in 'Pain Medicine' started by nvrsumr, Mar 27, 2007.

  1. nvrsumr

    nvrsumr Member 10+ Year Member

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    Anyone performing this procedure? Any literature to support this? Could not find anything on pubmed.

    Thanks
     
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  3. lobelsteve

    lobelsteve SDN Lifetime Donor Lifetime Donor Classifieds Approved 10+ Year Member

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    Have not seen any literature to support this. How about blocking the grc?
     
  4. nvrsumr

    nvrsumr Member 10+ Year Member

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    Definitely can do rami but if multiple discs affected this may be an alternative.

    Common pathway for lumbar rami comminicans and sinuvertebral nerve is likely sympathetic chain to L2 DRG-at least in rats. In theory since youre blocking nociceptive input from both the anterior and posterior annulus (by getting both grc and SVn) you may get better results.

    Ive seen a review article by Rozen 2001 Pain Pr. that shows L2 nerve root block(lidocaine) with an RF cannula (probably to stim) for discogenic pain dx/tx.

    Just interested if anyone has made this "next step"?
     
  5. lobelsteve

    lobelsteve SDN Lifetime Donor Lifetime Donor Classifieds Approved 10+ Year Member

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    We prefer to block the L2 GRC due to the convenience of not damaging a nerve root. Also, looking at the literature, there is no consensus as to what levels carry what fibers. Look at Bogdul's text and the gray rami are part of a vast neural network lying on the anterolateral vertebral body. I am under the impression that the gray rami network forms a confluence of fibers at the L2 GRC and then heads into the L2 root, up to the cord for somatotopic organization somewhere around the bottom of T8. We are reviewing our case series of GRC blocks and RF and may submit for publication this winter.
    I think the literature lags far behind what we are doing clinically. Tis as shame because I'm unsure if we can get paid for what we are doing while trying to help out these patients discognic LBP.
     
  6. mille125

    mille125 7+ Year Member

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    you will likely not get paid for doing thes procedures
     
  7. nvrsumr

    nvrsumr Member 10+ Year Member

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    Thanks Steve I appreciate your input. It does make sense that the lower lumber grc and SVn nerve fibers traveling up the sympathetic chain would have to travel thru the L2 grc to the DRG. The human anatomy is definitely poorly understood(at least by me) and likely variable.
     

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