Efficacy of Pulsed Radiofrequency Combine with Transforaminal Steroid Injection Compared to Conservative Management in Surgical Refusers with Lumbar Disc Herniation: A Retrospective Analysis

Background Lumbar disc herniation (LDH) frequently requires surgical intervention for severe radicular pain, but many patients decline surgery owing to underlying medical issues, advanced age, the likelihood of post-surgical complications or financial constraints, creating a clinical dilemma. This study investigates the efficacy of pulsed radiofrequency (PRF) combined with transforaminal epidural steroid injection (TFESI) versus conservative management in surgical candidates with LDH who refuse surgery. Methods This retrospective comparative study, conducted from January 2020 to December 2024, analyzed 56 patients with radicular pain secondary to LDH. Group A (n = 31) received PRF + TFESI, while group B (n = 25) underwent conservative management (pharmacotherapy, physiotherapy, observation). Outcomes were assessed using the Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI) for functional disability and Patient Satisfaction Score (PSS) at 1, 3, 6 and 12 months. Results Both groups demonstrated sustained effectiveness up to the 12-month follow-up, group A achieved rapid pain relief, VAS dropped from a baseline of 6.77 ± 1.05 to 2.52 ± 1.12 (p < 0.0001) and functional improvement with ODI decreasing from 75.8 ± 9.5% at baseline to 55.60 ± 8.15% (p < 0.0001) as early as the first month. During the first 6 months, pain reduction in group A was significantly greater than in group B (p < 0.0001). Regarding functional recovery, ODI scores in group A showed marked improvement compared to group B within the first 3 months (p < 0.0001); however, no significant differences between the two groups were observed at the 6- and 12-month follow-ups. PPS was notably higher in group A (3.51 ± 0.87 versus 2.11 ± 0.77, p < 0.0002) at 1 month follow-up. Conclusion Although outcomes converge by 12 months, PRF combined with TFESI offers rapid and substantial pain relief, improved function and high patient satisfaction compared to conservative treatment in LDH patients who decline surgery