后路法行神经根阻滞或脉冲射频术治疗神经根型颈椎病的临床探索

FEASIBILITY AND EFFICACY OF CERVICAL NERVE ROOT BLOCK AND PULSED RADIOFREQUENCY BY USING A POSTERIOR APPROACH IN PATIENTS WITH CERVICAL RADICULOPATHY

目的：探讨后路法行颈神经根阻滞或脉冲射频治疗神经根型颈椎病的安全性和有效性.方法：选择2010～2013年在深圳南山医院疼痛科住院并确诊为神经根型颈椎病的42例患者,完善术前准备,患者俯卧位在X线引导下从颈椎后路穿刺进针行神经根阻滞或脉冲射频术.术中记录测试时患者复制出疼痛的电刺激阈值,术后行神经根造影;用数字评分法（Numerical rating scales,NRS） （0～10分）来评估患者术前及术后3个月内疼痛与麻木的疗效.结果：在影像引导下成功地完成了42个病人共53个节段的阻滞与射频治疗.射频测试时每一节段均能诱发出患者相应区域的疼痛,感觉和运动的阈值分别为0.28±0.14（Ⅴ）和0.36±0.14（Ⅴ）.推注造影剂后有30个节段神经根显影良好,18个其次,5个较差.与术前相比,术后1天、1周、1个月和3个月患者的疼痛与麻木的VAS评分明显降低（P＜0.05）,但术后1天、1周、1个月和3个月三者之间无明显差异.所有患者均未出现严重并发症.结论：后入路法行颈神经根阻滞或射频是一种既安全又有效的方法.

Objective：Selective nerve block （SNB） and pulsed radiofrequency （PRF） to the dorsal root ganglion （DRG） appears to be an effective technique for chronic cervical radicular pain,but there have been various complications reported in the literature of the transformational route.The aim of this study was to evaluate the effectiveness and safety of selective cervical nerve root block （SCNRB） or pulsed radiofrequency via posterior approach in patients with chronic cervical radicular pain.Methods：This study was carried out on forty-two patients with unremitted cervical radicular pain refractory to conservative treatment.Those patients underwent SCNRB or PRF via posterior percuteous puncture approach in prone position under fluoroscopic guidance.The outcome of this procedure was measured according to the patient＇s feeling of electrical stimulation which covering the affected nerve distribution,fluoroscopic image of cervical nerve root via contrast and pain relief after procedure.Numerical rating scale （NRS） pain score was measured before treatment,1 week,1 month and 3 month after treatment.These patients were also evaluated carefully for complication or side effects.Results：A total of 53 procedures on 42 patients were done and with 8 procedures for C5,22 for C6,17 for C7 and 6 for C8.All patients had the experiences of paresthesia concordant to the usual pain distribution by using stimulation.The average thresholds of sensation and motor stimulation were 0.28 ± 0.14 （Ⅴ） and 0.36± 0.14 （Ⅴ）.Following the nonionic dye injection,the nerve images were obtained with 30 optimal contrast pattern,18 suboptimal distribution and 5 bad pattern.VAS and numbness improved statistically from preprocedure to 1 day,1 week,1 month and 3 months follow-up.No serious adverse effects were observed.Conclusion：Application of PRF to the cervical nerve root via posterior approach under the fluoroscopy appears to be an alternative,effective and relatively safe intervention technique for chronic cervical radicular pain refractory to conservative treatment.