Yang Dongfang, Xu Lichen, Hu Yutong, Xu Weibing
Spine Surgery Department, Dalian Medical University Affiliated Dalian Municipal Central Hospital, Shahekou District, Dalian, Liaoning, China.
Dalian Medical University, No. 9 Lvshun South Rd West Section, Lvshunkou District, Dalian, Liaoning, China.
Pain Ther. 2022 Jun;11(2):341-357. doi: 10.1007/s40122-022-00357-1. Epub 2022 Feb 15.
Cervical spondylotic radiculopathy (CSR) is one of the most common degenerative diseases of the spine that is commonly treated with surgery. The primary goal of surgery is to relieve symptoms through decompression or relieving pressure on compressed cervical nerves. Nevertheless, cutaneous pain distribution is not always predictable, making accurate diagnosis challenging and increasing the likelihood of inadequate surgical outcomes. With the widespread application of minimally invasive surgical techniques, the requirement for precise preoperative localization of the affected segments has become critical, especially when treating patients with multi-segmental CSR. Recently, the preoperative use of a selective nerve root block (SNRB) to localize the specific nerve roots involved in CSR has increased. However, few reviews discuss the currently used block approaches, risk factors, and other aspects of concern voiced by surgeons carrying out SNRB. This review summarized the main cervical SNRB approaches currently used clinically and the relevant technical details. Methods that can be used to decrease risk during cervical SNRB procedures, including choice of steroids, vessel avoidance, guidance with radiographs or ultra-sound, contrast agent usage, and other concerns, also are discussed. We concluded that a comprehensive understanding of the current techniques used for cervical SNRB would allow surgeons to perform cervical SNRB more safely.
神经根型颈椎病（CSR）是最常见的脊柱退行性疾病之一，通常采用手术治疗。手术的主要目标是通过减压或减轻受压颈神经的压力来缓解症状。然而，皮肤疼痛分布并不总是可预测的，这使得准确诊断具有挑战性，并增加了手术效果不佳的可能性。随着微创外科技术的广泛应用，对受影响节段进行精确术前定位的要求变得至关重要，尤其是在治疗多节段CSR患者时。最近，术前使用选择性神经根阻滞（SNRB）来定位CSR中受累的特定神经根的情况有所增加。然而，很少有综述讨论目前使用的阻滞方法、风险因素以及进行SNRB的外科医生所关注的其他方面。本综述总结了目前临床上主要使用的颈椎SNRB方法及相关技术细节。还讨论了可用于降低颈椎SNRB手术风险的方法，包括类固醇的选择、避免血管、使用X线片或超声引导、造影剂的使用以及其他关注点。我们得出结论，全面了解目前用于颈椎SNRB的技术将使外科医生能够更安全地进行颈椎SNRB。
