Gofeld Michael, Bhatia Anuj
Pain Management Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada.
Pain Pract. 2008 Jul-Aug;8(4):314-9. doi: 10.1111/j.1533-2500.2008.00210.x. Epub 2008 May 23.
The case report describes use of real-time ultrasound guidance to facilitate percutaneous ablation of cervical nerve roots in a patient with Pancoast's syndrome. Distortion of anatomy by the tumor made it difficult to perform the procedure safely using fluoroscopy. A 64-year-old right-handed male patient with carcinoma of the left lung presented with severe pain in the left shoulder and the arm. A clinical diagnosis of the left brachial plexopathy secondary to tumor involvement of C5 to C8 nerve roots was made. Radiological appearance of the cervical spine revealed distorted anatomy because of severe degeneration of the cervical spine and guarding torticollis. Diagnostic prognostic block of the C4 to C7 exiting nerve roots was done under ultrasound guidance and resulted in more than 75% reduction in pain intensity for 4 hours. Ultrasound-guided percutaneous cervical rhizotomy was performed later. At 3-month follow-up, the patient still had complete pain relief as well as improvement in quality of sleep. Ultrasound-guided cervical nerve roots ablation is a feasible approach for patients with intractable neuropathic pain secondary to Pancoast's tumor. It can be a useful alternative to fluoroscopy in patients in whom a fluoroscopy-guided approach is deemed difficult and hazardous.
该病例报告描述了在一名患有潘科斯特综合征的患者中使用实时超声引导来促进颈神经根的经皮消融。肿瘤导致的解剖结构变形使得使用荧光镜安全地进行该操作变得困难。一名64岁右利手男性患者，左肺癌，出现左肩和手臂严重疼痛。临床诊断为继发于C5至C8神经根肿瘤累及的左臂丛神经病变。颈椎的影像学表现显示由于严重的颈椎退变和保护性斜颈导致解剖结构变形。在超声引导下对C4至C7出神经根进行诊断性预后阻滞，结果疼痛强度在4小时内降低了75%以上。随后进行了超声引导下经皮颈神经根切断术。在3个月的随访中，患者仍有完全的疼痛缓解以及睡眠质量改善。超声引导下颈神经根消融对于继发于潘科斯特肿瘤的顽固性神经性疼痛患者是一种可行的方法。对于那些认为荧光镜引导方法困难且危险的患者，它可以是荧光镜的一种有用替代方法。
