一种新的颈背根神经节关节柱入路射频穿刺方法

A novel joint column approach puncture method for cervical dorsal root ganglion radiofrequency

摘要:

目的:背景:目前神经根型颈椎病微创介入手术多采用结节间沟入路行颈背根神经节(dorsal root ganglion,DRG)阻滞或射频调制治疗,实际上很难或无法到达我们解剖结构上的颈DRG,也有文章报道改进的方法,采用侧方位椎间孔穿刺入路,在实际操作中,该方法存在较大损伤神经根和椎动脉风险,事实上也难以到达DRG,本研究探讨超声引导下外侧关节柱入路行颈DRG脉冲射频治疗神经根型颈椎病的有效性、便捷性和安全性。方法:回顾分析2021年1月至2024年3月湖北医药学院附属太和医院疼痛科住院的30例神经根型颈椎病患者临床资料,均在超声引导下采用关节柱入路行颈DRG脉冲射频调制治疗,术中使用运动电刺激诱发神经支配区域的运动并使用 C型臂X光机验证穿刺针针尖与颈DRG位置关系。采用疼痛数字评分法(numerical rating scale, NRS) 表进行术前和术后疼痛程度评分,评价临床治疗效果,使用手术用时评价手术的便捷性,观察手术有无并发症评价该入路的安全性。结果:30例患者在超声下清晰显示颈DRG,穿刺顺利,运动电刺激在(0.3-0.8mv区间)诱发相应神经支配区域的运动,治疗过程中未发生严重并发症。结论:超声引导下外侧关节柱入路行颈DRG脉冲射频治疗神经根型颈椎病穿刺有效、便捷、安全。

Abstract:

Objective: Background: Currently, minimally invasive intervention surgery for cervical spondylotic radiculopathy mostly uses the interdendritic groove approach for cervical dorsal root ganglion (DRG) block or radiofrequency modulation therapy. In reality, it is difficult or impossible to reach the cervical DRG on our anatomical structure. There are also articles reporting improved methods that use a lateral intervertebral foramen puncture approach. In practical operation, this method has a significant risk of damaging the nerve root and vertebral artery, In fact, it is also difficult to reach DRG. This study explores the effectiveness, convenience, and safety of ultrasound-guided lateral articular column approach for cervical DRG pulse radiofrequency treatment of nerve root cervical spondylosis. Method: A retrospective analysis was conducted on the clinical data of 30 patients with cervical spondylotic radiculopathy admitted to the Pain Department of Taihe Hospital Affiliated to Hubei Medical University from January 2021 to March 2024. All patients underwent cervical DRG pulse radio frequency modulation treatment through the joint column approach under ultrasound guidance. During the surgery, motor electrical stimulation was used to induce movement in the nerve innervated area, and the relationship between the puncture needle tip and the cervical DRG position was verified using a C-arm X-ray machine. Using the numerical rating scale (NRS) for preoperative and postoperative pain assessment, evaluate clinical treatment effectiveness, evaluate surgical convenience using surgical time, and evaluate the safety of the approach by observing the presence of complications. Result: 30 patients showed clear cervical DRG under ultrasound, and the puncture was successful. Motor electrical stimulation induced movement in the corresponding nerve innervation area in the range of 0.3-0.8mv. No serious complications occurred during the treatment process. Conclusion: Ultrasound guided lateral articular column approach for cervical DRG pulse radiofrequency therapy is effective, convenient, and safe for puncture of nerve root type cervical spondylosis.