الفهرس 
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Abstract
Lumbar radicular pain (LRP) presents a common yet complex clinical challenge characterized by radiating pain in one or multiple dermatomes, often accompanied by chronic nerve irritation and dysfunction (Van Boxem et al., 2010). Despite its prevalence, LRP remains difficult to manage. Conservative treatments such as physical therapy or medication are typically the first-line approaches; however, they may not always yield satisfactory results. In such cases, interventional procedures become a viable option for further management of LRP. These procedures aim to directly target the underlying pathology contributing to the pain, providing relief when conservative measures prove ineffective. (Stafford et al., 2007).
Pulsed radiofrequency (PRF) represents a relatively newer approach in interventional pain management, characterized by the application of short pulses of radiofrequency current interspersed with longer pauses to prevent tissue damage from excessive heat accumulation (Van Zundert et al., 2007). While the precise mechanism of PRF remains under investigation, it is widely regarded as a nerve modulation technique rather than a destructive one. Clinical studies have demonstrated the safety and efficacy of PRF in treating various painful conditions, including lumbar radicular pain (LRP), by selectively targeting the lumbar dorsal root ganglion (DRG) with intermittent high-frequency currents (De et al., 2020). However, findings regarding the effectiveness of PRF on the lumbar DRG have been met with some controversy (Lee et al., 2016), and there are indications that the therapeutic effects observed may not be sustained over an extended period compared to PRF applied to other anatomical sites (Vuka et al., 2020). Further research is needed to elucidate the optimal parameters and long-term outcomes of PRF therapy for lumbar DRG-related pain.
Pulsed radiofrequency (PRF) therapy stands as a valuable tool in pain management, offering a non- or minimally neurodestructive approach through the application of short bursts of high-frequency current to target nervous tissue (Vanneste et al., 2017). The efficacy of PRF treatment is intricately linked to its parameters, with recent studies highlighting the notable enhancement in therapeutic outcomes with the use of high-voltage PRF, particularly in patients suffering from neuralgia (Wan et al., 2016). These findings underscore the importance of optimizing
PRF parameters to maximize clinical effectiveness and improve patient outcomes in the management of neuropathic pain.
Our study aimed to evaluate the efficacy of High-voltage pulsed radiofrequency on corresponding DRG in comparison to standard-voltage pulsed radiofrequency intervention in patients with chronic lumbosacral radicular pain.
Our study included 96 patients who were admitted for lumbar radicular pain, randomly divided into two groups:
• group 1: included 48 patients under went high-voltage pulsed radiofrequency.
• group 2: included 48 patients under went low- voltage pulsed radiofrequency.
Numeric Rating Scale was used to evaluate pain severity, at week 1, then at months 1, 2, 3 and 6 postoperative, and Oswestry low back disability questionnaire was used to evaluate how back pain has affected ability to manage everyday life, complications of the intervention were recorded.
Our study results showed that:
Our study found that there was No significant difference between the studied groups regarding age, sex, comorbidities, pain site, level of disc protrusion and number of nerve root compression. mean age was 55.0±11.7 vs 54.8±12.4 years in group 1 and group 2 respectively, 52.1 %were males in group 1 vs 43.8 % males in group 2.
The present study showed that NRS decreased significantly in both studied groups over the post intervention time in comparison to pre intervention time. However this decline was significantly more detected in group-I relative to group-II. The percentage of patients reporting numeric rating scale (NRS) reduction ≥50.0% was significantly higher in group-I than group-II at 1, 2, 3, and 6 months post-intervention
Oswestry score in high voltage group decreased rapidly in week-1 and month-1, then continue to decrease gradually in months-2,3 and 6. Oswestry score in standard voltage group decreased gradually from week-1 to month-6. No significant difference between the study groups regarding baseline Oswestry score, then Oswestry score became significantly lower in high voltage group than in standard voltage group.
Similarly our study showed that Oswestry low back disability score decreased significantly in the two studied groups at post intervention time in comparison to pre-intervention time. But this reduction was significantly more in group-I relative to group-II. The percentage of patients reporting Oswestry low back disability score reduction ≥50.0% was significantly higher in group-I than in group-II at 1,2,3,and 6 months post-intervention . The severity of disability measured by Oswestry grade was significantly lower in group-I than groupII at 2,3 and 6 month after intervention..
Also for complications did not occur in high voltage and standard voltage groups.
Our study concluded that:
High and standard-voltage pulsed radiofrequency adjacent to dorsal root ganglion provides significant improvement of radicular pain measured by NRS and patient function capacity measured by Oswestry disability index in patient with lumbosacral radicular pain associated disc prolapse However high -voltage pulsed radiofrequency radiofrequency gives more pain relief and enhancement of patient function status than standard PRF.