Lord S M, Barnsley L, Bogduk N
Cervical Spine Research Unit, University of Newcastle, Australia.
Neurosurgery. 1995 Apr;36(4):732-9. doi: 10.1227/00006123-199504000-00014.
Percutaneous radiofrequency neurotomy has been used in the treatment of pain from the cervical zygapophysial joints, but the results have been modest and not compelling. Several factors might account for its apparent poor success rate, including inadequate patient selection, inaccurate surgical anatomy, and technical errors. In an effort to overcome these confounders, we used comparative local anesthetic blocks to preoperatively, definitively diagnose cervical zygapophysial joint pain and developed an amended operative technique based on formal anatomical studies. An audit was conducted of our experience with 19 patients to determine whether there was sufficient merit in the amended procedure to justify a randomized, double-blind, controlled trial. The duration of complete pain relief was the principal outcome measure. Side effects and complications were also monitored. Of the 10 patients who underwent third occipital neurotomy for the treatment of C2-C3 zygapophysial joint pain, only 4 obtained long-lasting relief. The other six patients reported an early return of their pain and constituted technical failures; the third occipital nerve was inadequately coagulated and recovered in the immediate postoperative period. Of the 10 patients who underwent lower cervical medial branch neurotomy, 7 obtained complete pain relief for clinically useful periods and were able to resume their activities of daily living and employment. After procedures at all levels, a brief period of postoperative pain was experienced by the patients and ataxia was a side effect of third occipital neurotomy. There were no cases of postoperative infection or anesthesia dolorosa. Given the high technical failure rate of third occipital neurotomy, we recommend that this procedure be abandoned until the technical problems can be overcome.(ABSTRACT TRUNCATED AT 250 WORDS)
经皮射频神经切断术已用于治疗颈椎关节突关节疼痛，但效果一般且缺乏说服力。其成功率明显较低可能有几个因素，包括患者选择不当、手术解剖不准确和技术失误。为了克服这些混杂因素，我们使用对比性局部麻醉阻滞对颈椎关节突关节疼痛进行术前明确诊断，并基于正规解剖学研究开发了一种改良手术技术。我们对19例患者的经验进行了审计，以确定改良后的手术是否有足够的价值来开展一项随机、双盲、对照试验。主要结局指标是完全疼痛缓解的持续时间。还监测了副作用和并发症。在接受第三枕神经切断术治疗C2-C3关节突关节疼痛的10例患者中，只有4例获得了长期缓解。其他6例患者报告疼痛早期复发，属于技术失败；第三枕神经凝固不充分，术后短期内恢复。在接受下颈椎内侧支神经切断术的10例患者中，7例在临床上有用的时间段内获得了完全疼痛缓解，能够恢复日常生活和工作。在所有手术级别术后，患者都经历了一段短暂的术后疼痛，共济失调是第三枕神经切断术的副作用。没有术后感染或痛性麻木的病例。鉴于第三枕神经切断术的技术失败率较高，我们建议在技术问题得到克服之前放弃该手术。（摘要截选至250字）
