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Refractory Occipital Neuralgia – Preoperative Assessment with CT-Guided Nerve Block Prior to Dorsal Cervical Rhizotomy 2003

Kapoor V, Rothfus W.E., Grahovac S.Z., Horowitz MB
University of Pittsburgh Medical Center
Pittsburgh, PA

Purpose:
The purpose of the study was to assess the utility of CT-guided cervical nerve root block in selection of patients with occipital neuralgia for treatment by C1 – C4 dorsal rhizotomy.

Methods and Materials:
Medical records of 17 patients who had CT – fluoroscopy guided cervical nerve block and dorsal cervical rhizotomies were reviewed. Seventeen patients (males = 6; females = 11) with symptoms of occipital neuralgia underwent CT-fluoroscopy guided unilateral (n = 12) or bilateral (n = 5) cervical nerve root block (C2 = 5; C2 and C3 = 12) using a mixture of 2% lidocaine and methyl-predinisone. Mean age of patients was 43 years (range 17 to 76 years). Based on the results of cervical nerve block unilateral (n = 15) or bilateral (n = 2); C1 (n = 10), C2 (n = 17), C3 (n = 15), and/ or C4 (n = 5) rhizotomy was performed on all patients. Ten of seventeen patients have been followed for a mean of 24 months (range 12 to 36 months) for response to surgery in terms of: (a) relief of symptoms; (b) whether the surgery was worthwhile; and (c) the level of activity following surgery.

Results:
Seven of 10 patients had complete relief of symptoms, 3 patients had no relief. Two patients without relief had occipital neuralgia as a complication of head and neck surgery. One patient had temporary relief with recurrence of pain within weeks, the other 2 patients never benefited from the surgery. Six of 7 patients with complete relief of symptoms felt the surgery was worthwhile; 1 patient with complete relief developed new pain in the neck and shoulder that he attributed to rhizotomy and did not think the surgery was worthwhile. Five of 10 patients had greater level of activity with a more functional state than prior to procedure, there was no change in 3 patients and 2 patients had worsening level of activity.

Conclusion:
Preoperative assessment with CT – guided cervical nerve block in patients with refractory occipital neuralgia is useful for selecting patients who would benefit from dorsal cervical rhizotomy.