Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China.
Department of Pain, Zhejiang University of Traditional Chinese Medicine First Affiliated Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China.
Headache. 2022 Jul;62(7):839-847. doi: 10.1111/head.14361. Epub 2022 Jul 21.
To evaluate the feasibility and efficacy of computed tomography (CT)-guided radiofrequency ablation (RFA) of cervical intervertebral discs for the treatment of discogenic cervicogenic headache (CEH).
Some patients with CEH experience no obvious therapeutic effect after conventional therapy, particularly patients with refractory CEH originating from abnormal cervical intervertebral discs. Treatment for this type of CEH remains poorly characterized.
Using a single intervention arm, pretest/posttest design, we retrospectively analyzed the data of patients who underwent CT-guided RFA of cervical intervertebral discs for CEH at the Pain Medicine Center of Zhejiang Provincial People's Hospital from January 2017 to April 2021. If conservative treatment failed in patients with discogenic CEH, we classified the patients as having refractory CEH and performed RFA of cervical intervertebral discs. We used a numeric rating scale (NRS) to assess pain intensity for 6 months. We also compared therapeutic outcome of patients with different characteristics.
A total of 44 patients who underwent CT-guided RFA of cervical intervertebral discs were enrolled and 41 of them were analyzed in the present study. The preoperative median (25th, 75th) NRS score was 4 (4, 5), and it was significantly reduced to 1 (0, 4) 6 months after RFA (p < 0.001). The number of patients with ≥50% of their pain relieved after 6 months was 28 of 41 (68%). No serious treatment-related complications occurred in this study. Compared with single-level RFA, multi-level RFA shows greater effects on pain intensity reduction (p = 0.032) and pain relief rate (p = 0.047) of patients.
In patients who have discogenic CEH, CT-guided RFA of the cervical intervertebral discs appears to be a promising treatment with no serious complications.
评估计算机断层扫描（CT）引导下射频消融（RFA）治疗椎间盘源性颈源性头痛（CEH）的可行性和疗效。
一些 CEH 患者在常规治疗后没有明显的疗效，特别是起源于异常颈椎间盘的难治性 CEH 患者。这种类型的 CEH 的治疗仍不明确。
采用单干预臂、预测试/后测试设计，我们回顾性分析了 2017 年 1 月至 2021 年 4 月浙江省人民医院疼痛医学中心接受 CT 引导下颈椎间盘 RFA 治疗 CEH 的患者数据。如果椎间盘源性 CEH 患者的保守治疗失败，我们将患者归类为难治性 CEH 并进行颈椎间盘 RFA。我们使用数字评分量表（NRS）评估 6 个月的疼痛强度。我们还比较了不同特征患者的治疗效果。
共纳入 44 例接受 CT 引导下颈椎间盘 RFA 的患者，其中 41 例纳入本研究。术前中位数（25%，75%）NRS 评分为 4（4，5），RFA 后 6 个月显著降低至 1（0，4）（p<0.001）。41 例患者中，6 个月后疼痛缓解≥50%的患者有 28 例（68%）。本研究中无严重治疗相关并发症发生。与单节段 RFA 相比，多节段 RFA 对降低疼痛强度（p=0.032）和提高疼痛缓解率（p=0.047）的效果更大。
对于椎间盘源性 CEH 患者，CT 引导下颈椎间盘 RFA 似乎是一种有前途的治疗方法，且无严重并发症。
