Computed tomography‐guided radiofrequency ablation of cervical intervertebral discs for the treatment of refractory cervicogenic headache: A retrospective chart review

Abstract

Objective To evaluate the feasibility and efficacy of computed tomography (CT)‐guided radiofrequency ablation (RFA) of cervical intervertebral discs for the treatment of discogenic cervicogenic headache (CEH). Background Some patients with CEH experience no obvious therapeutic effect after conventional therapy, particularly patients with refractory CEH originating from abnormal cervical intervertebral discs. Treatment for this type of CEH remains poorly characterized. Methods Using a single intervention arm, pretest/posttest design, we retrospectively analyzed the data of patients who underwent CT‐guided RFA of cervical intervertebral discs for CEH at the Pain Medicine Center of Zhejiang Provincial People’s Hospital from January 2017 to April 2021. If conservative treatment failed in patients with discogenic CEH, we classified the patients as having refractory CEH and performed RFA of cervical intervertebral discs. We used a numeric rating scale (NRS) to assess pain intensity for 6 months. We also compared therapeutic outcome of patients with different characteristics. Results A total of 44 patients who underwent CT‐guided RFA of cervical intervertebral discs were enrolled and 41 of them were analyzed in the present study. The preoperative median (25th, 75th) NRS score was 4 (4, 5), and it was significantly reduced to 1 (0, 4) 6 months after RFA (p < 0.001). The number of patients with ≥50% of their pain relieved after 6 months was 28 of 41 (68%). No serious treatment‐related complications occurred in this study. Compared with single‐level RFA, multi‐level RFA shows greater effects on pain intensity reduction (p = 0.032) and pain relief rate (p = 0.047) of patients. Conclusion In patients who have discogenic CEH, CT‐guided RFA of the cervical intervertebral discs appears to be a promising treatment with no serious complications.

Safety and Efficacy of Radiofrequency Ablation and Epidural Steroid Injection for Management of Cervicogenic Headaches and Neck Pain: Meta-Analysis and Literature Review

“…Typically, structures innervated by the C1-C3 nerves can be responsible for cervicogenic headaches because of the physiological linkage of the top section of the cervical spinal cord and trigeminal nerves [23]. Cervical pain is a characteristic symptom of a wide range of headaches; hence, it does not conclusively establish the diagnosis of cervicogenic headache [16][17][18][19][20]. Cervicogenic headaches are principally unilateral and episodic with varying severity emanating from the neck to the ocular, occipital, frontal, and temporal region in a C-shaped configuration.…”

“…They established that, in most instances, the patients who underwent the RFA intervention typically experienced a high percentage of pain relief, with some of the patients even experiencing complete pain relief after the intervention [24,25]. The integration of RFA with technologies such as computed tomography has essentially increased the intervention's impact on pain intensity as the source of cervicogenic headache can be easily pinpointed, and completely ablated [12,17]. Generally, the efficiency of RFA as an interventional treatment for cervicogenic headache is increasingly becoming more effective, depending on the technology utilized in guiding the process.…”

“…According to Hamer and Purath, the average duration for improvement of cervicogenic headache is twentytwo-and-a-half weeks [15]. The duration required for an individual to experience pain relief of more than 50% can be reliably established in six months to one year [16][17][18].…”

“…Despite the high complication rate, most of the patients who have experienced RFA prefer to repeat the procedure in case of recurrence. Hu et al record a considerably lower complication rate, highlighting the role of technological advancement in the evolution and increasing efficacy of RFA as an intervention for CHA [17]. According to Lee et al, there were no complications for patients who underwent fluoroscopy-guided C2 dorsal root ganglion, which insinuates the complications in RFA can be essentially reduced through imaging guidance during the ablation [16].…”

“…Finding a successful treatment is of utmost clinical significance since CHA does not get better with time, unlike other secondary headaches. Therefore, this study looks at radiofrequency ablation and epidural steroid injection to identify their safety and efficacy in managing patients with cervicogenic headaches and neck pain [16][17][18][19].…”