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Document Type

Original Study

Abstract

Background Data: Cervical radicular pain is a significant community problem secondary to multiple pathologies, mostly disc herniation, and spondylotic foraminal stenosis. Despite conservative treatment, about 10% of patients still suffer chronic pain. Previous clinical studies reported promising results of using fluoroscopy-guided transforaminal pulsed radiofrequency (PRF) and nonparticulate steroid injection. However, there is a risk of vascular or nerve injury.

Purpose: To evaluate the feasibility and efficacy of ultrasound- (US-) guided technique for extraforaminal PRF and dexamethasone injection in managing chronic cervical radicular pain.

Study Design: A clinical prospective case series.

Patients and Methods: This study was conducted on 15 patients, eight males and seven females, diagnosed clinically and radiologically with cervical radicular pain. All patients underwent US-guided PRF and dexamethasone injection for corresponding extraforaminal nerve root for 6 minutes using local anesthesia. All patients were followed up at 1, 3, and 6 months regarding pain relief using the numerical rating scale (NRS), and the Neck Disability Index (NDI) percentage was used for evaluating functional disability before and at 6 months after the procedure. The success rate was defined as a ≥50% reduction of the mean NRS as compared to the preintervention score.

Results:There were no intra- or postprocedural complications, and there was no neurological or vascular injury. In all included patients, the targeted extraforaminal cervical nerve root was easily counted and identified within the intertubercular groove with its underlying bone acoustic shadow. The mean preprocedural NRS was 7.4 (±0.99 SD), which dropped after the procedure at 1-, 3-, and 6-month follow-up to 3.7, 3.1, and 2.9, respectively. Consequently, the NRS improvement percentage was 60.8 % at the 6-month follow-up (p-value

Conclusion: US-guided technique for extraforaminal pulsed radiofrequency and dexamethasone injection is a feasible, reliable, and effective minimally invasive method for managing chronic cervical radicular pain. A randomized comparative study with a control group and a longer duration of follow-up is recommended for future studies.

Keywords

brachialgia management, cervical disc prolapse, cervical radicular pain, cervical spondylosis, foraminal stenosis, pulsed radiofrequency, ultrasound-guided.

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