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

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 (p < 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 (p < 0.05). The decrease in surgical level disc height was more pronounced in the PRF + PCN group at the final follow-up (P < 0.05). The ROM was reduced in the PRF group but increased in the PRF + PCN group at the final follow-up (P < 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 (P > 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.

Keywords: cervical radicular pain; outcomes; percutaneous cervical nucleoplasty; pulsed radiofrequency; ultrasound guidance.

Figure 1

Surgical diagram of PCN and PRF.

Figure 2

x-ray of cannula position. (A) Anterior–posterior and (B) lateral view of cannulation at initial surgical site. (C) The second site of laser decompression is located in the middle of intervertebral disc, confirmed by the lateral view of fluoroscopy.

Figure 3

Ultrasound identification of cervical nerve roots. (A) Characteristics of horizontal nodules of C4 nerve root: there were two nodules in front and back under ultrasound, and the internodal sulci was shallow. (B) Characteristics of horizontal nodules of C5 nerve roots: there were two nodules in front and back under ultrasound, and the internodal sulci was deep. (C) Characteristics of horizontal nodules of C6 nerve roots: there were two nodules in front and back under ultrasound, and the anterior nodules of C6 protruded more than the posterior nodules. (D) Characteristics of C7 nerve root horizontal tubercle: Anterior transverse tubercle of C7 is underdeveloped, only posterior tubercle. C4: Fourth cervical nerve root, C5: fifth cervical nerve root, C6: sixth cervical nerve root, C7: seventh cervical nerve root. AT, anterior tubercle; PT, posterior tubercle.

Figure 4

Results of the clinical efficacy of the functional scores. (A) Change in A-VAS scores over time. (B) Changes in the N-VAS scores over time. (C) Changes in NDI scores over time. (D) Changes in CASCS scores over time. A-VAS, arm visual analog scale; N-VAS, neck visual analog scale; NDI, neck disability index; CASCS, neck disability index. * Indicates a significant difference between the two groups.

Figure 5

Clinical outcomes of the PRF and PRF + PCN groups at the last follow-up.