Epidural Adhesiolysis and Dorsal Root Ganglion Pulsed Radiofrequency Through a Single Multifunctional Catheter: A Narrative Review and Illustrated Technical Report

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.