Ultrasound-guided caudal epidural pulsed radiofrequency for the treatment of failed back surgery syndrome: Results of a prospective clinical study.

Background: The first aim of this study was to investigate the analgesic efficacy of US-guided caudal epidural pulsed radiofrequency (PRF) stimulation in patients with failed back surgery syndrome (FBSS); the second was to evaluate the effects on opioid use, disability, quality of life and patient satisfaction. Methods: Thirty patients with > 6-month history of chronic leg pain of >4 on a numerical rating scale (NRS) due to FBSS were included. These patients had unsatisfactory responses to conventional treatments and at least two epidural steroid injections. PRF stimulation with ultrasound guidance was administered to the caudal epidural space. NRS was evaluated before treatment, at 2, 4, and 8 weeks after intervention. Short Form-36 (SF-36) for health-related quality of life, Oswestry Disability Index (ODI), changes in opioid use and patient satisfaction were evaluated at baseline and 8 weeks after treatment. Results: Mean NRS scores were significantly lower at weeks 2, 4 and 8 compared to baseline (P ​< ​0.001). There were significant improvements in SF-36 and ODI scores compared with pretreatment (P ​< ​0.05). It was found that 31% and 13% of opioid users, respectively, discontinued and tapered off their opioid medication. 40% of patients were overall satisfied with the treatment. Conclusion: In a cohort of patients with FBSS, caudal epidural PRF stimulation provided pain relief in 36% of treated subjects. Patients also experienced significant improvement in functionality, quality of life and opioid use. This technique can be considered as an alternative before considering neuromodulation, opiate therapy, or reoperation in patients with FBSS.