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等离子椎间盘切除术缓解超声引导神经根阻滞阳性后的颈胸痛:一项回顾性研究。

Coblation Discoplasty Alleviates Cervical Chest Pain After Positive Ultrasound-Guided Nerve Root Block: A Retrospective Study.

机构信息

Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China.

Department of Pain Management, Changzhou Cancer Hospital, Changzhou, China.

出版信息

World Neurosurg. 2021 Jul;151:e927-e934. doi: 10.1016/j.wneu.2021.05.009. Epub 2021 May 12.

Abstract

OBJECTIVE

Cervical chest pain (CCP), as 1 atypical symptom associated with cervical spondylosis, often overlaps with other chest-related diseases. CCP obviously relieved after ultrasound-guided cervical nerve root block near a herniated disc should be considered as a potential pathologic source. The purpose of this study is to investigate whether coblation discoplasty can alleviate CCP after positive ultrasound-guided nerve root block.

METHODS

From August 2016 to September 2019, 21 patients with high suspicion of CCP experienced over 50% pain relieve after ultrasound-guided diagnostic nerve root block. Through 12 months of follow-up, the primary efficacy was assessed with visual analogue scale (VAS) of CCP, and secondary outcomes included: neck pain VAS, neck disability index (NDI), the proportion of significant CCP relief, the rating of CCP alleviation, the patient satisfaction index (PSI), and analgesic consumption. Adverse events were recorded to evaluate safety.

RESULTS

Following postoperative 12 months, a time-course analysis confirmed a robust decline in VAS of CCP (P < 0.0001), and a similar recovery trend was shown in VAS of neck pain and NDI (P < 0.0001). After treatment, the number of patients taking analgesics decreased (P < 0.0001), and around 60% of patients reported notable relief and satisfaction with treatment. No serious complications were observed.

CONCLUSIONS

After positive ultrasound-guided nerve root block, coblation discoplasty can provide up to 12 months of relief for intractable CCP.

摘要

目的

颈椎胸痛(CCP)作为与颈椎病相关的一种非典型症状,常与其他与胸部相关的疾病相重叠。如果在超声引导下椎间盘突出症附近的神经根阻滞治疗后 CCP 明显缓解,应考虑为潜在的病理来源。本研究旨在探讨等离子消融椎间盘切除术(coblation discoplasty)在超声引导下神经根阻滞阳性后是否能缓解 CCP。

方法

从 2016 年 8 月至 2019 年 9 月,21 例高度怀疑 CCP 的患者在超声引导下诊断性神经根阻滞治疗后疼痛缓解超过 50%。通过 12 个月的随访,采用 CCP 的视觉模拟评分(VAS)评估主要疗效,次要结局包括:颈部疼痛 VAS、颈部残疾指数(NDI)、CCP 缓解的显著比例、CCP 缓解的评分、患者满意度指数(PSI)和镇痛药的消耗。记录不良事件以评估安全性。

结果

术后 12 个月的时间进程分析证实,CCP 的 VAS 显著下降(P < 0.0001),颈部疼痛和 NDI 的 VAS 也呈现出相似的恢复趋势(P < 0.0001)。治疗后,服用镇痛药的患者数量减少(P < 0.0001),约 60%的患者报告治疗效果显著,并对治疗感到满意。未观察到严重并发症。

结论

在超声引导下神经根阻滞阳性后,等离子消融椎间盘切除术可为难治性 CCP 提供长达 12 个月的缓解。

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