Safety and Efficacy of CT-Guided Pulsed Radiofrequency Combined with Steroid and Ozone Injection-Treated Cervical 3-8 Herpes Zoster Neuralgia Using a Posterior and Upper Quarter of the Cervical Foramina Puncture Approach

Abstract

Background: Herpes zoster neuralgia has a considerable impact on people's quality of life, especially after the development of postherpetic neuralgia. There are many clinical reports on the treatment of herpes zoster neuralgia, but there have been no special reports on the treatment of herpes zoster involving the neck. Our research focuses on a posterior and upper quarter of the cervical foramina puncture approach for herpes zoster involving the cervical 3-8 (C3-8) nerve region and to consider the safety and efficacy of pulsed radiofrequency combined with steroid injection and ozone injection in this puncture path under CT guidance. Materials and Methods: A total of 104 patients with herpes zoster neuralgia involved in the cervical 3-8 nerve region use a posterior and upper quarter of the cervical foramina puncture approach received pulsed radiofrequency combined with steroid and ozone injection to the dorsal root ganglion. The total number of injection procedures, complications, NRS collection (preprocedure, postprocedure at once, two, four and 12 weeks) and drug dose decreases were documented. Results: During a total of 257 procedures, 254 procedures successfully completed PRF (3 cases failed to reach the C8 aim points), and the rate of puncture failure was 1.17%. Drug injection was successfully performed in 252 procedures (the injection success rate was 99.21%); the NRSs (preprocedure, postprocedure at once, two, four and twelve weeks) were 5.75 ± 0.682, 2.6 ± 1. 023, 2.21 ± 0.925, 1.89 ± 1.162, and 1.43 ± 1.369, and the difference among them was statistically significant. Drug dosages decreased before and after operation and showed statistically significant differences. Conclusion: Pulsed radiofrequency combined with steroid and ozone injection for herpes zoster neuralgia involving the C3-8 nerves under CT guidance through a posterior superior quarter approach showed safety and efficacy and had a high success rate, and the NRS decreased significantly.

Combined Therapy of Paravertebral Nerve Pulsed Radiofrequency and Subcutaneous Block for Acute/subacute Herpetic Neuralgia

“…Another study has also reported a longer pain relief duration and a lower pain score and analgesic dosage when using CT-guided PRF in acute stage than in subacute stage 2 . All these may be attributed to the fact that as the disease developed, pain relief becomes more difficult due to a cascade of events such as local scarring and fascial contracture, central sensitization, and amplification of psychological disorder 5 . What’s more, it is generally believed that central damage began to occur even at 9 to 12 days after acute onset 31 .…”

“…2 All these may be attributed to the fact that as the disease developed, pain relief becomes more difficult due to a cascade of events such as local scarring and fascial contracture, central sensitization, and amplification of psychological disorder. 5 What's more, it is generally believed that central damage began to occur even at 9 to 12 days after acute onset. 31 So, the optimal timing of intervention for HZ requires further investigation.…”

“…2 HN features severe spontaneous pain as burning, stabbing, or shooting pain, imposing both physical and mental torments for those affected. 3 Delayed and ineffective treatment may lead to PHN, the most common complication occurring in 5% to 34% of HZ patients, 4,5 which could last for months to even years after the shingles have healed, posing a financial burden to health care systems worldwide. 6 Treatments for acute/subacute HN include medications (eg, antiviral drugs, nonsteroidal anti-inflammatory drugs, opioids, anticonvulsants, antidepressants and so on), and interventional techniques (nerve block or destruction, radiofrequency modulation, electrical stimulation), but systematic reviews have shown that no option is considered adequate to alleviate the stubborn pain without risk.…”

“…HN features severe spontaneous pain as burning, stabbing, or shooting pain, imposing both physical and mental torments for those affected 3 . Delayed and ineffective treatment may lead to PHN, the most common complication occurring in 5% to 34% of HZ patients, 4,5 which could last for months to even years after the shingles have healed, posing a financial burden to health care systems worldwide 6 …”

Progress in Radiofrequency Therapy for Zoster-Associated Pain About Parameters, Modes, Targets, and Combined Therapy: A Narrative Review

“…Combining treatments with diverse targeting mechanisms is believed to result in a more effective therapeutic response for ZAP. For example, combinations such as DRG pulsed radiofrequency with steroids, ozone, local anesthetics or recombinant human interferon-a2b, as well as pulsed radiofrequency combined with continuous radiofrequency or heat acupuncture are applied for ZAP [38][39][40][41][42][43][44][45][46]. Numerous clinical studies have focused on the combination of pulsed radiofrequency and ozone, consistently demonstrating the safety and effectiveness of this treatment modality [40][41][42][43].…”