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Abstract
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Background and Aims Osteosarcoma is a primary malignant bone tumor that represents 3 to 6% of all childhood cancers, severe refractory pain is a symptom with a frequency of up to 50%. Continous radiofrequency technique aims to increase local temperature with high frequency waves, through vibration of the surrounding particles, while pulsed radiofrequency has a neuromodulatory effect in the transmission of the pain stimuli.
Methods 5-year-old male, with blunt trauma 5 months prior to the onset of symptoms, presenting with severe chronic right knee pain, with lower limb MRI with a space-occupying lesion, biopsy showed conventional high-grade osteosarcoma of chondroblastic and osteoblastic pattern of the right distal femur, with refractory pain to pharmacological management.
Results In prone position, with radiographic guidance the vertebral bodies L4-L5 were located, we proceded to locate right foramina and advanced a radiofrequency needle with active tip of 10mm to the dorsal root ganglion of L3-L4 and L4-L5, sensitive tests were performed with 50Hz for 0.3V and then motor test with 2Hz by 1V confirming the stimulation of the dorsal root ganglion with distribution along the area of pain, we proceeded to infuse analgesic mixture and then pulsed radiofrequency was performed at 42°C for 5minutes per level, the procedure ended without complications.
Conclusions Despite the limitations in scientific evidence and experience, interventions in pediatrics are generally performed with scarce evidence and based on experience in adults. Radiofrequency of dorsal root ganglion is described as a safe and low-risk procedure, with high benefits in the control of low back and lower limb pain.
Fluoroscope image in AP projection with needle in position level L4-L5, application of contrast medium and dispersion of contrast medium