45 V vs 60 V Pulsed Radiofrequency of the Cervical Dorsal Root Ganglion for Cervical Radicular Pain

Pulsed radiofrequency (PRF) applied to the dorsal root ganglion (DRG) is a well-established minimally invasive treatment for patients with cervical radicular pain who do not respond adequately to conservative management. Although PRF has demonstrated favorable efficacy and safety, the optimal procedural parameters, particularly the applied voltage, remain uncertain. Previous studies have reported conflicting findings regarding the influence of voltage on treatment outcomes, with some suggesting improved long-term pain relief with higher voltages, while others have associated lower voltage settings with better clinical results. More recent evidence has shown favorable outcomes with higher-voltage PRF in cervical radicular pain; however, direct comparisons between commonly used voltage settings, such as 45 V and 60 V, are lacking.

The primary aim of this study is to compare the effectiveness of 45 V and 60 V PRF applied to the cervical DRG in patients with cervical radicular pain using the Numerical Rating Scale (NRS). Secondary aims include comparing functional outcomes using the Neck Disability Index (NDI) and evaluating the safety of both treatment protocols by comparing the incidence of procedure-related adverse events.

Patients who have undergone cervical DRG PRF for cervical radicular pain and completed their treatment will be evaluated according to the voltage applied during the procedure (45 V or 60 V). Pain intensity will be assessed using the Numerical Rating Scale (NRS), and functional disability will be evaluated using the Neck Disability Index (NDI) before treatment and at 3 and 6 months after the procedure. In addition to between-group comparisons, changes from baseline within each group will also be analyzed. Procedure-related adverse events will be recorded throughout the follow-up period.

Inclusion criteria

• Unilateral cervical radicular pain consistent with cervical disc herniation.
• Pain intensity of ≥6 on the Numerical Rating Scale (NRS).
• Radicular pain persisting for at least 3 months.
• MRI evidence of lower cervical nerve root compression consistent with clinical findings.
• Inadequate response to conservative treatment, including analgesic medications and physical therapy.
• Completion of cervical dorsal root ganglion pulsed radiofrequency (PRF) treatment.

Exclusion criteria

• Bilateral upper extremity pain or predominant axial neck pain.
• Cervical spinal stenosis, spondylolisthesis, cervical myelopathy, or other structural spinal disorders causing radicular pain.
• Previous cervical spine surgery at the target level.
• Cognitive impairment preventing reliable outcome assessment.
• Active local or systemic infection.
• Coagulopathy or inability to discontinue anticoagulant/antiplatelet therapy for the procedure.
• Severe hepatic or renal failure.
• Pregnancy.
• Unstable psychiatric disorders.
• Any condition that could interfere with completion of follow-up evaluations.