Abstract:

The patients with herpes zoster and thoracic spine injury or degeneration often suffer from thoracic neuralgia. In severe cases， severe pain may affect sleep and daily life， and conservative treatment often yields poor results. At present， the most common minimally invasive surgical option in clinical practice is CT-guided thoracic spinal nerve root radiofrequency ablation. However， the application of CT guidance has certain limitations， such as a history of tumor in the patient， or physical inability to maintain the prone position for a long time， which may affect the operation， and the problems such as excessive radiation exposure and（or） puncture failure often occur. This article reported the application of ultrasound combined with CT-guided percutaneous spinal nerve root radiofrequency technique （PSNRRT） in the treatment of thoracic neuralgia， which effectively assisted the successful completion of the operation. Patient 1， a 63-year-old female， had postherpetic neuralgia （PHN）； Patient 2， a 58-year-old male， had lumbar vertebral fracture complicated with thoracic neuralgia after a car accident. Both patients had difficulty in maintaining the prone position for a long time， and the operations were successfully completed using ultrasound combined with CT-guided PSNRRT. The postoperative records showed that the operation time and the number of radiation exposures in both patients were less than those in patients who underwent CT-guided surgery alone， and there was no significant difference in the evaluation of treatment effect. Puncture under ultrasound combined with CT guidance is performed under real-time visualization， which may reduce radiation and shorten operation time. This method not only ensures the accuracy and safety of puncture， but also reduces operation time and radiation exposure time， and the postoperative effect is definite. This study provides a new idea for the radiofrequency treatment of thoracic spinal neuralgia， and its feasibility is further confirmed by clinical operation. The long-term efficacy and advantages need to be further verified by large-sample studies.

Key words: Computed tomography, Ultrasound, Thoracic neuralgia, Postherpetic neuralgia, Radiofrequency ablation