Department of Neurosurgery, University of Ulm, Ulm, Germany.
Department of Neurosurgery, University of Ulm, Ulm, Germany; Department of Neurosurgery, Nova Clinic Biberach, Biberach, Germany.
Pain Physician. 2018 May;21(3):285-294.
Among the various causes of vertigo, the so-called cervicogenic vertigo (CV) has been the most controversial. However, perturbations of proprioceptive signals and abnormal activity of the cervical afferents can induce vertigo. Medial branch blocks (MBBs) are a diagnostic tool designed to test whether a patient's neck pain is mediated by one or more of the medial branches of the dorsal rami of the spinal nerve. It is unknown whether MBBs are also suitable for testing symptoms other than pain.
The purpose of this study was to test whether MBBs of the cervical spine can be used as a diagnostic tool to identify patients with CV.
A retrospective practice audit (clinical observation).
An interventional pain management and spine practice.
An electronic medical record system was used to identify patients in a single spine center. Included were consecutive patients with neck pain and vertigo, who had received cervical MBBs in a period from July 2001 to April 2016. The patients were tested with a MBB of about 1 mL of bupivacaine (0.25%) and 20 mg triamcinolone. Injections were performed with fluoroscopic visualization using established techniques in 2 or 3 levels on one or both sides. Vertigo was analyzed through the global clinical impression of the patient (i.e., "gone," "better," "the same," or "worse").
One-hundred seventy-eight patients met the inclusion criteria. One-hundred eleven patients (62.4%) experienced a significant improvement of the vertigo. In 47 patients (26.4%), no information about the vertigo was available at follow-up; these patients were assumed to have no improvement (worst-case scenario). Hence, altogether 67 patients (37.6%) had a negative result. The median relief of the vertigo was 2 months. Differences in age, gender, level of treatment, or pain duration between patients with relief of the vertigo and without relief were not found. Nine patients with a whiplash injury in their medical history were also tested. They experienced a lower success rate and had longer duration of pain before the treatment; however, these differences are not statistically significant.
It was the primary intention to treat neck pain; the assessment of vertigo was an additional aim. Therefore, the history taken and the clinical examination were not targeted specifically to vertigo. A placebo effect cannot be excluded. Further studies with the primary focus on CV are necessary to prove the significance of MBBs.
This is the first study to demonstrate that MBBs of the cervical spine can be a useful tool for the diagnosis of CV, because they temporarily block cervical afferents. In 63.4% of patients with neck pain and suspected CV, the vertigo was significantly improved. Further placebo-controlled studies with the primary intention on CV are necessary to prove the significance of MBBs.
Cervicogenic vertigo, medial branch block, facet joint, zygapophysial joint, neck pain, differential diagnosis.
在各种眩晕病因中，所谓的颈源性眩晕（CV）最具争议。然而，本体感觉信号的改变和颈椎传入神经的异常活动可引起眩晕。内侧支阻滞（MBB）是一种诊断工具，旨在测试患者的颈部疼痛是否由脊神经背支的一个或多个内侧支介导。目前尚不清楚 MBB 是否也适用于测试疼痛以外的其他症状。
本研究旨在测试颈椎 MBB 是否可作为一种诊断工具，以识别 CV 患者。
回顾性实践审核（临床观察）。
介入性疼痛管理和脊柱实践。
使用电子病历系统在单一脊柱中心识别患者。纳入标准为 2001 年 7 月至 2016 年 4 月期间接受颈椎 MBB 的颈痛和眩晕连续患者。使用 2 或 3 个水平的单侧或双侧约 1 毫升布比卡因（0.25%）和 20 毫克曲安奈德进行测试。使用既定技术进行透视可视化注射。通过患者的整体临床印象（即“消失”、“更好”、“相同”或“更差”）分析眩晕。
178 例符合纳入标准。111 例（62.4%）患者的眩晕明显改善。47 例（26.4%）患者在随访时没有关于眩晕的信息；这些患者被假定为无改善（最糟糕的情况）。因此，共有 67 例（37.6%）患者的结果为阴性。眩晕缓解的中位数为 2 个月。在有缓解和无缓解的患者之间，年龄、性别、治疗水平或疼痛持续时间没有差异。9 例有挥鞭伤病史的患者也接受了测试。他们的成功率较低，治疗前疼痛持续时间较长；然而，这些差异没有统计学意义。
主要目的是治疗颈部疼痛；眩晕的评估是一个附加目的。因此，病史采集和临床检查并非专门针对眩晕。不能排除安慰剂效应。需要进一步的以 CV 为主要重点的研究来证明 MBB 的重要性。
这是第一项表明颈椎 MBB 可作为 CV 诊断的有用工具的研究，因为它们可暂时阻断颈椎传入神经。在 63.4%的颈痛和疑似 CV 患者中，眩晕明显改善。需要进一步的以 CV 为主要重点的安慰剂对照研究来证明 MBB 的重要性。
颈源性眩晕，内侧支阻滞，关节突关节，椎间关节，颈痛，鉴别诊断。
