Radiofrequency Neurotomy for the Treatment of Therapy-resistant Neck Pain after Ventral Cervical Operations

Abstract

The objective of this study was to determine if radiofrequency neurotomy is effective for patients with postoperative neck pain after cervical spine operations. The study design used was a retrospective practice audit. Review of charts of all patients who underwent cervical spine operations for degenerative reasons during a time period of 2.5 years. Patients with persistent postsurgical neck pain were treated with therapeutic medial branch blocks (local anesthetic and steroid). If pain recurred, diagnostic medial branch blocks were performed. Patients with at least 80% relief following both the therapeutic and the diagnostic block underwent radiofrequency neurotomy. Positive treatment response was defined for at least 50% reduction of pain or sufficiently satisfaction of the patient. Two hundred forty-two operations were performed, 125 of which were artificial disc operations, 66 were stand alone cages, and 51 were fusions with cage and plate. Two patients were lost to follow-up. Persistent neck pain occurred in 31% of the patients. The prevalence of zygapophysial pain after surgery was 13.2%. These 32 patients were treated with radiofrequency neurotomy because of recurrent neck pain. The average follow-up time was 15 months. A significant pain reduction was achieved in 59.4%. Significantly, after a double-level operation, more patients suffered persisting neck pain (P=0.002) compared with all patients being operated. Zygapophysial joints are a possible source of postoperative pain after anterior cervical spine surgery. Persistent and therapy-resistant neck pain occurs more often in patients after double-level operation. Radiofrequency neurotomy can provide an effective treatment for persistent neck pain after ventral cervical spine surgery.