Epidural Adhesiolysis and Dorsal Root Ganglion Pulsed Radiofrequency Through a Single Multifunctional Catheter: A Narrative Review and Illustrated Technical Report
8 affiliations
- 1Unit of Anesthesia, Analgesia and Percutaneous Surgery, Fondazione Istituto G. Giglio, Cefalù, 90015 Palermo, Italy
- 2Department of Anesthesiology and Pain Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- 3Comprehensive Specialty Care, Oklahoma City, OK 73112, USA
- 4Advanced Spine on Park Avenue, New York, NY 10022, USA
- 5Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
- 6Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy
- 7Pain Therapy Unit, Azienda Ospedaliera Sandro Pertini, 00157 Rome, Italy
- 8Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
Abstract
Percutaneous epidural adhesiolysis and pulsed radiofrequency of the dorsal root ganglion (DRG-PRF) target two distinct components of chronic lumbosacral radicular pain: the restricted access of injected drugs to a nerve root shielded by epidural fibrosis, and the sensitization of the ganglion itself. A multifunctional steerable catheter carrying a bipolar electrode at its tip makes it technically feasible to perform both at the same anatomical target within a single procedure. This narrative review and illustrated technical report has three aims: to summarize the mechanistic rationale for each component (mechanical adhesiolysis, enzymatic lysis with recombinant human hyaluronidase, DRG-PRF, and the co-administered local anesthetic and corticosteroid); to describe the combined procedure step by step—landmarks, needle angles, radiofrequency parameters, injectate composition, safety checkpoints and the epidurographic endpoint—with original schematics; and to set out critically what the evidence does and does not establish. A structured but non-systematic search of MEDLINE and Embase identified a substantial, methodologically contested literature on adhesiolysis, a smaller one on hyaluronidase, and a single randomized trial of 41 patients directly comparing adhesiolysis with and without DRG-PRF. Mechanistic plausibility and technical feasibility are therefore well supported, whereas evidence of clinical benefit for the combined protocol is limited. The suggested place of the technique in the treatment pathway—as an interventional option in selected patients before surgical escalation, or when revision surgery is being considered—is a clinical proposal based on anatomical reasoning and single-center experience, not on comparative data. Comparative studies are needed to define its role.
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BibTeX
@article{bianco2026epidural,
title = {{Epidural Adhesiolysis and Dorsal Root Ganglion Pulsed Radiofrequency Through a Single Multifunctional Catheter: A Narrative Review and Illustrated Technical Report}},
author = {Giuliano Lo Bianco and Miles Day and Douglas P. Beall and Sudhir Diwan and Alaa Abd-Elsayed and Matteo Luigi Giuseppe Leoni and Felice Occhigrossi and Marco Mercieri and Marco Cascella and Francesco Paolo D’Angelo},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208094},
url = {https://www.mdpi.com/2077-0383/15/20/8094},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Epidural Adhesiolysis and Dorsal Root Ganglion Pulsed Radiofrequency Through a Single Multifunctional Catheter: A Narrative Review and Illustrated Technical Report
AU - Giuliano Lo Bianco
AU - Miles Day
AU - Douglas P. Beall
AU - Sudhir Diwan
AU - Alaa Abd-Elsayed
AU - Matteo Luigi Giuseppe Leoni
AU - Felice Occhigrossi
AU - Marco Mercieri
AU - Marco Cascella
AU - Francesco Paolo D’Angelo
PY - 2026
DA - 2026/10/19
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208094
UR - https://www.mdpi.com/2077-0383/15/20/8094
AB - Percutaneous epidural adhesiolysis and pulsed radiofrequency of the dorsal root ganglion (DRG-PRF) target two distinct components of chronic lumbosacral radicular pain: the restricted access of injected drugs to a nerve root shielded by epidural fibrosis, and the sensitization of the ganglion itself. A multifunctional steerable catheter carrying a bipolar electrode at its tip makes it technically feasible to perform both at the same anatomical target within a single procedure. This narrative review and illustrated technical report has three aims: to summarize the mechanistic rationale for each component (mechanical adhesiolysis, enzymatic lysis with recombinant human hyaluronidase, DRG-PRF, and the co-administered local anesthetic and corticosteroid); to describe the combined procedure step by step—landmarks, needle angles, radiofrequency parameters, injectate composition, safety checkpoints and the epidurographic endpoint—with original schematics; and to set out critically what the evidence does and does not establish. A structured but non-systematic search of MEDLINE and Embase identified a substantial, methodologically contested literature on adhesiolysis, a smaller one on hyaluronidase, and a single randomized trial of 41 patients directly comparing adhesiolysis with and without DRG-PRF. Mechanistic plausibility and technical feasibility are therefore well supported, whereas evidence of clinical benefit for the combined protocol is limited. The suggested place of the technique in the treatment pathway—as an interventional option in selected patients before surgical escalation, or when revision surgery is being considered—is a clinical proposal based on anatomical reasoning and single-center experience, not on comparative data. Comparative studies are needed to define its role.
SN - 2077-0383
ER -