| ObjectivesCervical spondylosis is a clinical common disease.It has 4 types,respectively,cervical spondylotic radiculopathy,cervical spondylosis,vertebral artery type cervical spondylosis and sympathetic cervical spondylosis.Cervical spondylotic radiculopathy(CSR)is the most common in all types of cervical spondylosis.About 60% ~ 70% of cervical spondylosis.Especially in the age of aging,the incidence of aged patients with cervical spondylosis is increasing.The current treatment of CSR mainly for the cause,such as physical therapy,surgery and minimally invasive interventional therapy.Physical therapy,including hand massage,mandibular pillow traction,etc,to relieve muscle spasms,increase intervertebral space,reduce the nerve root compression and stimulation.The aged patients with CSR often take conservative treatment,easy to relapse and ineffective.Due to the large surgical trauma and high cost of surgery,aged patients often complicated by multiple diseases,so with high surgical risk and poor postoperative recovery.Many patients have undergone surgical treatment for cervical spondylosis,and there has been no significant relief or even increased pain after surgery.Therefore,the treatment of aged patients with CSR is limited.With the gradual maturity of minimally invasive techniques such as radiofrequency(RF),a more alternative treatment for aged patients with CSR is provided.In this study,ultrasound and CT-guided radiofrequency ablation combined with injection through the cervical intervertebral foramen in the treatment of aged patients with CSR and just injection in the treatment of aged patients with CSR,compared the clinical effects of two different treatments on elderly patients with CSR.Methods50 aged patients with CSR were randomly divided into two groups using a random number table method.The test group(T group)and the control group(C group)are each 25 cases.The course of treatment are first under ultrasound for body surface location,and then the test group are under the guidance of CT.The test group(T group,n=25),treated with radiofrequency thermocoagulation(55 ℃ 60 s,60 ℃ 120 s,65 ℃ 60s)+Injection antiphlogistic and analgesic(prescription: 0.25% lidocaine + 10 mg dexamethasone + iohexol,a total of 4ml).The control group(n=25)were only treated with anti-inflammatory analgesic(prescription: 0.25% lidocaine + 10 mg dexamethasone + Sterile saline,a total of 4ml).The control group need to be treated with 4 courses,once a week,after the end of 4 courses then follow-up.Both groups underwent ultrasound to puncture through the cervical intervertebral foramen.The outcome of the review evaluated both safety and efficacy.The safety is mainly to see of vascular,nerve injury intraoperative and numbness,neurological dysfunction postoperative.The effectiveness evaluation mainly used the visual analogue scale(VAS)score before treatment,1 month after the treatment and 6 months after the treatment,to evaluate the clinical efficacy at 6 months after the treatment and the patients’ satisfaction.ResultsAll patients were treated successfully,among them,5 elderly CSR patients in the observation group were lost to follow-up,2 patients in the control group were lost to follow-up,and 3 patients were withdrawn from treatment midway.The final test group of 20 patients included in the statistical analysis,the control group is 20 patients too.During and after treatment,none of patients showed vascular and nerve injury,no patient had numbness and neurological dysfunction after operation.All patients were followed up 1 month and 6 months after treatment.Compared with before,pain VAS scores of test group and control group were lower.(T group:3.00±1.22 vs 8.1±0.77;C group:5.25±0.89 vs 7.95±0.80),at 6 months after the treatment,the VAS scores of pain in test group and control group were also lower than before(T group:1.4±1.32 vs 8.1±0.77;C group:4.05±1.20 vs 7.95±0.80),1 month and 6-month after the treatment,T group’s pain VAS score decreased more significantly(1 month after the treatment:3.00±1.22 vs 5.25±0.89;6 month after the treatment:1.4±1.32 vs 4.05±1.20).There was significant difference between two groups(P<0.05).The clinical efficacy of the test group was as high as 85%,and the control group was only 45%.There was significant difference between two groups(P<0.05).All aged patients with CSR are satisfied with this treatment.The satisfaction of both the test group and the control group was 100%.ConclusionsOur pain center by treating 40 elderly patients with CSR found that,as a treatment between conservative and surgical,ultrasound and CT-guided radiofrequency thermocoagulation combined with injection through the cervical intervertebral foramen in the treatment of aged patients with CSR is a simple and safe and effective treatment,it can relief pain longer,and have better clinical efficacy,while compared with the simple injection therapy,so it is an ideal treatment for aged patients with CSR,and compared to the surgery,the treatment it have low cost,and have less trauma in the aged,it is worth in-depth promotion and research in clinical practice in the future. |
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