J Korean Med Sci.  2006 Feb;21(1):119-125. 10.3346/jkms.2006.21.1.119.

Radiofrequency Neurotomy of Cervical Medial Branches for Chronic Cervicobrachialgia

• Shin WR
• Kim HI
• Shin DG
• Shin DA

• KMID: 2157794
• DOI: http://doi.org/10.3346/jkms.2006.21.1.119

Abstract

Chronic neck and arm pain or cervicobrachialgia commonly occurs with the degeneration of cervical spine. Authors investigated the usefulness of radiofrequency (RF) neurotomies of cervical medial branches in patients with cervicobrachialgia and analyzed the factors which can influence the treatment outcome. Demographic data, types of pain distribution, responses of double controlled blocks, electrical stimulation parameters, numbers and levels of neurotomies, and surgical outcomes were evaluated after mean follow-up of 12 months. Pain distribution pattern was not significantly correlated with the results of diagnostic blocks. Average stimulation intensity was 0.45 V, ranging from 0.3 to 0.69, to elicit pain response in cervical medial branches. The most common involvement of nerve branches was C4 (89%), followed by C5 (82%), C6 (75%), and C7 (43%). Among total of 28 patients, nineteen (68%) reported successful outcome according to outcome criteria after 6 months of followup (p=0.001), and eight (42%) of 19 patients reported complete relief (100%) of pain. Four patients showed recurrence of pain between 6 and 12 months. It was therefore concluded that cervical medial branch neurotomy is considered useful therapeutic modality for the management of cervicobrachialgia in selected patients, particularly in degenerative zygapophyseal disorders.

Keyword

Neck pain; Cervicobrachialgia; Neurotomy; Radiofrequency; Catheter Ablation; Cervical Vertebrae

MeSH Terms

Adult
Aged
Aged, 80 and over
Back Pain/etiology/surgery
Brachial Plexus/pathology/*surgery
Brachial Plexus Neuritis/complications/diagnosis/*surgery
Chronic Disease
Electrosurgery/methods
Female
Humans
Male
Middle Aged
Neck Pain/etiology/surgery
Nerve Block/methods
Neurosurgical Procedures/instrumentation/*methods
Treatment Outcome

Figure

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  Fig. 1 Pain distribution patterns in the patients with degenerative cervical spine. Type A denotes the pain distribution in the lower neck (A); type B demonstrates the pain in the neck and shoulder (B); type C indicates the pain in lower neck, shoulder, sometimes scapula, and upper arm (C).

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  Fig. 2 Radiograph of cervical spine anteroposterior (A) and lateral view (B) demonstrating the location of needles for nerve blocks branches performed on C4, C5, C6 and C7 medial branches.

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  Fig. 3 Schematic drawing demonstrating the targets of radiofrequency neurotomy of cervical medial branch. VR, ventral ramus; DR, dorsal ramus; LB, lateral branch; MB, medial branch; DRG, dorsal root ganglion; SN, sinuvertebral nerve.

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