Wang Ran, Zhu Tong, Han Ying
Department of Pain Management, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Pain Physician. 2023 May;26(3):E171-E179.
Pulsed radiofrequency (PRF) treatment of the dorsal root ganglia (DRG) has recently been used as an important option for postherpetic neuralgia (PHN) patients who do not respond well to drugs. This procedure is commonly guided by computed tomography (CT) or fluoroscopy, but they cannot be performed in real time and are associated with radiation exposure. Ultrasound (US) is a potential alternative option, but no reliable method of US-guided DRG PRF treatment has been reported.
The goal of this study was to propose a method for performing US-guided transforaminal PRF on cervical DRG. By comparing the results with those of CT guidance, we also sought to assess the accuracy, safety, and efficacy of this new approach in the treatment of PHN.
A retrospective cohort study.
The study took place at the department of pain management of a single academic medical center.
The data of 73 PHN patients receiving 2 sessions of US-guided (US group, n = 26) or CT-guided (CT group, n = 47) cervical DRG PRF were reviewed. US-guided DRG PRF was performed using our proposed protocol. The one-time success rate was used to assess accuracy. The average radiation dose, the number of scans per operation, and the rate of complications were recorded for safety assessment. For the evaluation of pain amelioration, a Numeric Rating Scale (NRS-11), the daily sleep interference score (SIS), and oral medication (i.e., anticonvulsants and analgesics) usage 2 weeks, 4 weeks, 12 weeks, and 24 weeks after treatment were compared to the baseline values and between groups.
The one-time success rate in the US group was significantly higher than that in the CT group (P < 0.05). Compared those of the CT group, the mean radiation dose and number of scans per operation were both obviously lower in the US group (P < 0.05). The average operation time was also shorter in the US group (P < 0.05). No obvious serious complications occurred in either group. No obvious between-group difference was found in the NRS-11 score, daily SIS, or rate of oral medications at any of the time points (P > 0.05). The NRS-11 score and SIS significantly decreased after treatment at each follow-up time point (P < 0.05) in both groups. Compared with those at baseline, the use rate of anticonvulsants and analgesics obviously decreased 4 weeks, 12 weeks, and 24 weeks after treatment (P < 0.05).
This study was limited by its nonrandomized and retrospective design.
US-guided transforaminal DRG PRF is a safe and effective method for the treatment of cervical PHN. It is a reliable alternative option to the CT-guided procedure, demonstrating great advantages in reducing radiation exposure and the operation time.
脉冲射频（PRF）治疗背根神经节（DRG）最近已成为对药物治疗反应不佳的带状疱疹后神经痛（PHN）患者的重要选择。该操作通常由计算机断层扫描（CT）或荧光透视引导，但它们不能实时进行且与辐射暴露相关。超声（US）是一种潜在的替代选择，但尚未有关于超声引导下DRG PRF治疗的可靠方法的报道。
本研究的目的是提出一种在颈椎DRG上进行超声引导下经椎间孔PRF的方法。通过将结果与CT引导的结果进行比较，我们还试图评估这种新方法在治疗PHN中的准确性、安全性和有效性。
一项回顾性队列研究。
该研究在一家学术医疗中心的疼痛管理部门进行。
回顾了73例接受2次超声引导（超声组，n = 26）或CT引导（CT组，n = 47）颈椎DRG PRF的PHN患者的数据。超声引导下的DRG PRF使用我们提出的方案进行。一次性成功率用于评估准确性。记录平均辐射剂量、每次手术的扫描次数和并发症发生率以进行安全性评估。为了评估疼痛改善情况，比较了治疗后2周、4周、12周和24周的数字评分量表（NRS-11）、每日睡眠干扰评分（SIS）以及口服药物（即抗惊厥药和镇痛药）的使用情况与基线值以及组间情况。
超声组的一次性成功率显著高于CT组（P < 0.05）。与CT组相比，超声组的平均辐射剂量和每次手术的扫描次数均明显更低（P < 0.05）。超声组的平均手术时间也更短（P < 0.05）。两组均未发生明显严重并发症。在任何时间点，NRS-11评分、每日SIS或口服药物使用率在组间均未发现明显差异（P > 0.05）。两组在每个随访时间点治疗后NRS-11评分和SIS均显著降低（P < 0.05）。与基线相比，治疗后4周、12周和24周抗惊厥药和镇痛药的使用率明显降低（P < 0.05）。
本研究受其非随机和回顾性设计的限制。
超声引导下经椎间孔DRG PRF是治疗颈椎PHN的一种安全有效的方法。它是CT引导手术的可靠替代选择，在减少辐射暴露和手术时间方面显示出巨大优势。
