Finiels P-J, Batifol D
Unité de neurochirurgie et pathologie rachidienne, polyclinique KenVal-Site Kennedy, avenue Kennedy, 30900 Nîmes, France.
Neurochirurgie. 2010 Oct;56(5):374-81. doi: 10.1016/j.neuchi.2010.08.004. Epub 2010 Sep 25.
Postoperative neck pain after cervical spinal surgery is a common occurrence, the prevalence of which can reach up to 60%. Since 2005 a prospective study, still in progress, is attempting to show the efficacy of botulinum toxin injections in its treatment.
Two hundred and fifteen patients operated on in the same institution for cervical spondylotic myelopathy were prospectively followed-up; 38 of them presented postoperative neck pain and were enrolled either in a course of botulinum toxin injections (19) or in conservative treatment (19). The muscles injected, in descending order, were: trapezius, supraspinalis, splenius capitis, and rhomboids. Injections were made using Type A-botulinum toxin (Botox*-Allergan Pharmaceuticals, Westport, Ireland), increasing from 20 to 100U Botox* without exceeding 300U once in the same patient, performed every 3 months if necessary. The conservative treatment consisted of a course of thiocolchicoside (16mg/day) and physical rehabilitation. The lordosis angle was calculated on lateral sitting radiographs in the neutral position immediately postoperatively and 1.5 months after injection and correlated to pain improvement evaluated by the visual analogic scale (VAS).
No visible improvement was found on x-rays in three patients after injection, and in 11 after conservative treatment. In 16 cases, after an average of three injections, the gain in lordosis averaged 11.3° and the VAS score was decreased by 4.6 points versus 4.7° and a decrease of 0.6 points after conservative treatment.
Regardless of its limitations, the present study would seem to show potential value in the use of botulinum toxin in the treatment of postoperative pain after cervical spinal surgery.
颈椎手术后颈部疼痛是常见现象，其发生率可达60%。自2005年起一项仍在进行的前瞻性研究试图证明肉毒毒素注射治疗该病的疗效。
对在同一机构接受手术治疗的215例脊髓型颈椎病患者进行前瞻性随访；其中38例出现术后颈部疼痛，被纳入肉毒毒素注射疗程组（19例）或保守治疗组（19例）。注射的肌肉按比例依次为：斜方肌、竖脊肌、头夹肌和菱形肌。使用A型肉毒毒素（保妥适*-爱尔兰韦斯特波特艾尔建制药公司生产）进行注射，剂量从20U增加到100U，同一患者单次不超过300U，必要时每3个月注射一次。保守治疗包括服用硫代秋水仙碱疗程（16mg/天）和物理康复治疗。术后即刻及注射后1.5个月在中立位坐位侧位X线片上计算脊柱前凸角，并与视觉模拟评分法（VAS）评估的疼痛改善情况相关联。
注射后3例患者X线片上未见明显改善，保守治疗后11例未见明显改善。16例患者平均注射三次后，脊柱前凸平均增加11.3°，VAS评分降低4.6分；而保守治疗后脊柱前凸平均增加4.7°，VAS评分降低0.6分。
尽管存在局限性，但本研究似乎显示了肉毒毒素在治疗颈椎手术后疼痛方面的潜在价值。
