背景和目的:神经根型颈椎病(CR)表现为上肢的疼痛和感觉运动障碍,通常是由于椎间盘突出引起的神经根压迫,退行性变化,或者外伤.虽然最初首选保守治疗,持续或严重的病例可能需要手术干预。超声引导的选择性神经根阻滞(SNRB)已成为缓解症状并可能消除手术需要的有希望的干预措施。这项研究评估了超声引导下SNRB治疗慢性CR的疗效。旨在确定其在症状缓解和延迟或避免外科手术方面的潜力。材料与方法:对2019年10月至2022年3月接受CR治疗的720例门诊患者进行回顾性分析。排除创伤性CR患者后,以前的手术,恶性肿瘤,进行性神经系统症状需要立即手术,或者保守治疗不足,92例经历颈神经根性疼痛超过3个月并且在保守治疗超过6周后VAS评分≥5的患者被包括在内。患者接受了单个或多个超声引导的SNRB程序,在实时超声引导下注射地塞米松和利多卡因。在基线时评估症状严重程度,以及在术后4、8和12周使用视觉模拟量表(VAS)。收集的数据包括年龄,性别,颈部和/或神经根疼痛的存在,体检结果,症状复发,症状改善,以及最终是否需要手术干预。进行统计分析以确定与症状改善或复发相关的因素。结果:SNRB后69名(75.0%)参与者症状明显改善,55(79.7%)在4周时表现出改善,11(15.9%)在8周,和3(4.4%)在12周。症状复发,定义为在至少一个月的无痛间隔后,VAS评分增加并伴有持续至少24小时的疼痛发作,在48例(52.2%)患者中发现。颈部和神经根联合疼痛的存在是复发的重要预测因素(p=0.008)。在症状缓解和年龄等因素之间没有发现显着关联,性别,初始疼痛严重程度,或MRI检查结果。结论:超声引导下SNRB可有效治疗慢性CR,提供实质性的症状缓解,并可能减少手术干预的需要。这种技术提供了一种有希望的保守治疗选择,特别是考虑到其实时可视化的优势和最小的辐射暴露。
Background and Objectives: Cervical radiculopathy (CR) manifests as pain and sensorimotor disturbances in the upper extremities, often resulting from nerve root compression due to intervertebral disc herniation, degenerative changes, or trauma. While conservative treatments are initially preferred, persistent or severe cases may require surgical intervention. Ultrasound-guided selective nerve root block (SNRB) has emerged as a promising intervention for alleviating symptoms and potentially obviating the need for surgery. This study evaluates the therapeutic efficacy of ultrasound-guided SNRB in managing chronic CR, aiming to determine its potential in symptom relief and delaying or avoiding surgical procedures. Materials and Methods: A retrospective analysis was conducted on 720 outpatients treated for CR between October 2019 and March 2022. After excluding patients with traumatic CR, previous surgeries, malignancies, progressive neurological symptoms requiring immediate surgery, or inadequate conservative treatment, 92 patients who had experienced cervical radicular pain for more than three months and had failed to improve after more than six weeks of conservative treatment with VAS scores ≥ 5 were included. The patients underwent single or multiple ultrasound-guided SNRB procedures, involving the injection of dexamethasone and lidocaine under real-time ultrasound guidance. Symptom severity was assessed at the baseline, and at 4, 8, and 12 weeks post-procedure using the Visual Analog Scale (VAS). The data collected included age, sex, presence of neck and/or radicular pain, physical examination findings, recurrence of symptoms, improvement in symptoms, and whether surgical intervention was ultimately required. Statistical analyses were performed to identify the factors associated with symptom improvement or recurrence. Results: Significant symptom improvement was observed in 69 (75.0%) participants post-SNRB, with 55 (79.7%) showing improvement at 4 weeks, 11 (15.9%) at 8 weeks, and 3 (4.4%) at 12 weeks. Symptom recurrence, defined by an increase in VAS score accompanied by a pain flare lasting at least 24 h after a pain-free interval of at least one month, was noted in 48 (52.2%) patients. The presence of combined neck and radicular pain was a significant predictor of recurrence (p = 0.008). No significant associations were found between symptom relief and factors such as age, gender, initial pain severity, or MRI findings. Conclusions: Ultrasound-guided SNRB effectively manages chronic CR, providing substantial symptom relief and potentially reducing the need for surgical intervention. This technique offers a promising conservative treatment option, especially given its real-time visualization advantages and minimal radiation exposure.