title: A posterior approach to cervical nerve root block and pulsed radiofrequency treatment for cervical radicular pain: a retrospective study.
abstract: BACKGROUND
  Catastrophic complications have been reported for selective cervical nerve root block (SCNRB) or pulsed radiofrequency (PRF) via an anterolateral transforaminal approach. A posterior approach to these procedures under computed tomography guidance has been reported. Here, we report the clinical outcomes of 42 patients with chronic cervical radicular pain (CCRP) treated with a combination of SCNRB and PRF through a posterior approach under fluoroscopy guidance.
  
  
  METHODS
  We retrospectively reviewed the clinical outcomes of 42 consecutive patients with CCRP who received a combination of SCNRB and PRF through a posterior approach under fluoroscopy guidance. The thresholds of electrical stimulation and imaging of the nerve roots after contrast injection were used to evaluate the accuracy of needle placement. The numeric rating scale was used to measure the pain and numbness levels as primary clinical outcomes, which were evaluate in scheduled follow-up visits of up to 3 months.
  
  
  RESULTS
  A total of 53 procedures were performed on 42 patients at the levels of C5-C8. All patients reported concordant paresthesia in response to electrical stimulation. The average sensory and motor thresholds of stimulation were 0.28 ± 0.14 and 0.36 ± 0.14 V, respectively. Injection of nonionic contrast resulted in excellent spread along the target nerve root in large majority of the procedures. The numeric rating scale scores for both pain and numbness improved significantly at 1 day, 1 week, and 1 and 3 months after the treatment. No serious adverse effects were observed in any of the patients.
  
  
  CONCLUSIONS
  The posterior approach to combined SCNRB and PRF under fluoroscopy guidance appears to be safe and efficacious in the management of CCRP.
authors.affiliation: Department of Pain Management of Shenzhen Nanshan Hospital, Guangdong Medical College, Shenzhen, China 518052. Electronic address: nsyyjoe@live.cn.
authors.forename: Lizu
authors.initials: L
authors.lastname: Xiao
authors.affiliation: Department of Pain Management of Shenzhen Nanshan Hospital, Guangdong Medical College, Shenzhen, China 518052.
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Pain Management of Shenzhen Nanshan Hospital, Guangdong Medical College, Shenzhen, China 518052.
authors.forename: Disen
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Pain Management of Shenzhen Nanshan Hospital, Guangdong Medical College, Shenzhen, China 518052.
authors.forename: Dong
authors.initials: D
authors.lastname: Yan
authors.affiliation: Department of Pain Management of Shenzhen Nanshan Hospital, Guangdong Medical College, Shenzhen, China 518052.
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Pain Management, Cleveland Clinic, Cleveland, OH, USA 44195; Department of Neurosciences, Cleveland Clinic, Cleveland, OH, USA 44195.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Pain Management, Cleveland Clinic, Cleveland, OH, USA 44195; Department of Neurosciences, Cleveland Clinic, Cleveland, OH, USA 44195.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D004558:Electric Stimulation; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D006987:Hypesthesia; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000628:therapy*; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D061208:Pulsed Radiofrequency Treatment / Q000379:methods*; D011843:Radiculopathy; D012189:Retrospective Studies; D013126:Spinal Nerve Roots; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Chronic cervical radicular pain (CCRP); Numeric rating scale (NRS); Pulsed radiofrequency (PRF); Selective cervical nerve root block (SCNRB)