Department of Pain Medicine, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China.
Department of Anesthesiology, Ruijin Hospital/Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Pain Physician. 2022 Aug;25(5):E767-E775.
Post-herpetic neuralgia (PHN) is a typical neuropathic pain. Conventional oral analgesics and nerve block therapy can only obtain temporary analgesia in many cases. This study summarized the clinical effect of CT-Guided intervertebral foramen puncture and radiofrequency thermocoagulation through the superior margin of costotransverse joint for the treatment of refractory PHN in the superior thoracic segment.
To observe the efficacy of CT-Guided intervertebral foramen puncture and radiofrequency thermocoagulation (RFT) treatment of refractory PHN in the T1 ~ T3 spinal innervation area.
A retrospective, observational study.
Pain department, Jiaxing and Hangzhou, China.
Thirty-six patients with intractable superior thoracic PHN were admitted to the Pain Department. After the positioning image of CT was taken by prone, the upper thoracic segment was scanned in axial position with the layer thickness of 3 mm of spinal model.The puncture path was designed by selecting the slice of the foramen and costotransverse joint from the obtained images. The needle was inserted to the corresponding foramen. After confirmation by high and low frequency current stimulation tests, the RFT was performed at 90°C for 180s. A numeric rating scale (NRS) for pain was recorded before surgery, 2 hours, 1 week, 4 weeks and 8 weeks after surgery and the mental state was assessed with the SF-36 clinical questionnaire before surgery, 4 weeks and 8 weeks after surgery.
Following RFT intervention the measured pain NRS significantly decreased after 2 hours, 1 week, 4 weeks and 8 weeks (P < 0.01). SF-36 scores in all categories increased 4 and 8 weeks after the operation (P < 0.01). No serious adverse effects were reported during the study period and no hypoxemia was found under intraoperative nasal catheter oxygen inhalation.
Limitations of this study include the small sample size, and nonrandomized retrospective design.
CT-Guided intervertebral foramen puncture and RFT through the superior margin of the costotransverse joint can effectively improve refractory PHN in the superior thoracic segment with good safety.
带状疱疹后神经痛（PHN）是一种典型的神经病理性疼痛。在许多情况下，常规的口服镇痛药和神经阻滞疗法只能获得暂时的镇痛效果。本研究通过 CT 引导椎间孔穿刺和射频热凝术治疗 T1~T3 脊神经支配区的难治性胸上段 PHN，总结其临床疗效。
观察 CT 引导椎间孔穿刺和射频热凝术（RFT）治疗 T1~T3 脊神经支配区难治性 PHN 的疗效。
回顾性、观察性研究。
中国嘉兴和杭州疼痛科。
36 例难治性胸上段 PHN 患者入院。患者取俯卧位，行 CT 定位扫描，以获取胸椎模型的轴向 3mm 层厚扫描图像。从获得的图像中选择椎间孔和肋横突关节的层面来设计穿刺路径，将穿刺针插入相应的椎间孔。高频和低频电流刺激测试确认后，在 90°C 下进行 180s 的 RFT。记录术前、术后 2 小时、1 周、4 周和 8 周的疼痛数字评分量表（NRS），并在术前、术后 4 周和 8 周使用 SF-36 临床问卷评估精神状态。
RFT 干预后，术后 2 小时、1 周、4 周和 8 周的测量疼痛 NRS 显著降低（P＜0.01）。术后 4 周和 8 周时，所有类别 SF-36 评分均升高（P＜0.01）。研究期间未报告严重不良事件，术中鼻导管吸氧未见低氧血症。
本研究的局限性包括样本量小，以及非随机回顾性设计。
CT 引导椎间孔穿刺和经肋横突关节上方射频热凝术可有效改善胸上段难治性 PHN，且安全性良好。
