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经皮颈椎间盘髓核成形术联合超声引导下颈神经根脉冲射频治疗神经根型颈椎病的临床及影像学比较:一项回顾性匹配队列研究

Clinical and radiological comparison of percutaneous cervical nucleoplasty combined with ultrasound-guided pulsed radiofrequency of cervical nerve root for cervical radicular pain: a retrospective, matched-cohort study.

作者信息

Wang Baodong, Song He, Wang Tianyi, Du Peng, Zang Lei, Yang Lihui

机构信息

Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

出版信息

Front Pain Res (Lausanne). 2025 Jul 23;6:1618608. doi: 10.3389/fpain.2025.1618608. eCollection 2025.


DOI:10.3389/fpain.2025.1618608
PMID:40771650
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12325311/
Abstract

BACKGROUND: The best treatment yielding clinical benefits was still equivocal and controversial for the treatment of cervical radicular pain (CRP). This study aimed to propose a novel combination strategy of percutaneous cervical nucleoplasty (PCN) and ultrasound-guided pulsed radiofrequency (PRF) of cervical nerve root for CRP, and to compare its therapeutic effects with PRF alone. METHODS: 120 CRP patients who satisfied the inclusion requirements between January 2016 and March 2019 were retrospectively analyzed and split into PCN + PRF and PRF groups. The propensity score matching (PSM) technique was used to correct the imbalanced confounding variables between the groups. Then, clinical outcomes including the visual analog scale (VAS) score, Neck Disability Index (NDI) score, clinical assessment scale for cervical spondylosis (CASCS), modified MacNab criteria, radiological parameters, and complications were evaluated. RESULTS: In all, 120 patients were used to calculate the propensity score, producing 26 matched pairs that were monitored for a minimum of a year. When compared to the preoperative data, both groups' neck pain VAS scores, arm pain VAS scores, NDI scores, and CASCS scores saw a significant improvement during the follow-up period ( < 0.001). However, patients in the PRF group noted higher neck pain VAS scores, arm pain VAS scores, NDI scores, and CASCS scores than those in the PRF + PCN group at the final follow-up ( < 0.05). The decrease in surgical level disc height was more pronounced in the PRF + PCN group at the final follow-up ( < 0.05). The ROM was reduced in the PRF group but increased in the PRF + PCN group at the final follow-up ( < 0.01). Based on the modified MacNab criteria, the PRF and PCN + PRF groups had excellent and good rates of 76.92% and 84.62%, respectively, with no statistically significant difference ( > 0.05). CONCLUSION: We present and describe a novel strategy for the combined treatment of CRP in chronic cervical radicular pain using ultrasound-guided percutaneous disc radiofrequency ablation PCN and spinal nerve root pulse radiofrequency PRF, which is both effective and safe throughout the treatment process, reducing pain and improving function.

摘要

背景:对于颈神经根性疼痛(CRP)的治疗,能产生临床益处的最佳治疗方法仍不明确且存在争议。本研究旨在提出一种用于CRP的经皮颈椎间盘成形术(PCN)和超声引导下颈神经根脉冲射频(PRF)的新型联合策略,并将其治疗效果与单纯PRF进行比较。 方法:回顾性分析2016年1月至2019年3月期间120例符合纳入标准的CRP患者,并将其分为PCN + PRF组和PRF组。采用倾向得分匹配(PSM)技术校正两组间不均衡的混杂变量。然后,评估包括视觉模拟量表(VAS)评分、颈部功能障碍指数(NDI)评分、颈椎病临床评估量表(CASCS)、改良MacNab标准、影像学参数和并发症等临床结局。 结果:总共120例患者用于计算倾向得分,产生26对匹配对,对其进行至少一年的监测。与术前数据相比,两组在随访期间颈部疼痛VAS评分、手臂疼痛VAS评分、NDI评分和CASCS评分均有显著改善(<0.001)。然而,在末次随访时,PRF组患者的颈部疼痛VAS评分、手臂疼痛VAS评分、NDI评分和CASCS评分高于PRF + PCN组(<0.05)。在末次随访时,PRF + PCN组手术节段椎间盘高度的降低更为明显(<0.05)。在末次随访时,PRF组的活动度降低,而PRF + PCN组的活动度增加(<0.01)。根据改良MacNab标准,PRF组和PCN + PRF组的优良率分别为76.92%和84.62%,差异无统计学意义(>0.05)。 结论:我们提出并描述了一种使用超声引导下经皮椎间盘射频消融PCN和脊神经根脉冲射频PRF联合治疗慢性颈神经根性疼痛中CRP的新策略,该策略在整个治疗过程中均有效且安全,可减轻疼痛并改善功能。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebc4/12325311/062588f5edcb/fpain-06-1618608-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebc4/12325311/29cc8ad1bc3a/fpain-06-1618608-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebc4/12325311/9b2b5e37eb46/fpain-06-1618608-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebc4/12325311/742dae8fc9eb/fpain-06-1618608-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebc4/12325311/114e8a5368d3/fpain-06-1618608-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebc4/12325311/062588f5edcb/fpain-06-1618608-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebc4/12325311/29cc8ad1bc3a/fpain-06-1618608-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebc4/12325311/9b2b5e37eb46/fpain-06-1618608-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebc4/12325311/742dae8fc9eb/fpain-06-1618608-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebc4/12325311/114e8a5368d3/fpain-06-1618608-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebc4/12325311/062588f5edcb/fpain-06-1618608-g005.jpg

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J Pain Res. 2022-5-17

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The mechanism of action of pulsed radiofrequency in reducing pain: a narrative review.

J Yeungnam Med Sci. 2022-7

[10]
Management of Cervical Spondylotic Radiculopathy: A Systematic review.

Global Spine J. 2022-10

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