1 case of nerve pain after the radiofrequency treatment of shingles in the side lysue CT under C8T1 spinal nerve root radiofrequency therapy

1Case informationpatient He, male, 79 years oldDue to "right chest back, right upper limb side skin herpes after severe pain 49 days" visitThe patient 49 days ago appeared right chest back, right armpit, right upper limb side of the hair burn-like tingling, 2 days later the pain of the corresponding parts appear edifice, check into the dermatology treatmentAfter 14 days herpes clots fall off, but there is still intense burst pain, poor drug treatment, visual simulation score (visual analogue scale, VAS) 5 to 8 pointsThis time with "post herpes after nerve pain (post herpetic neuralgia, PHN) " hospital admissioncheck body: Shenqing, mental poor, primary herpes area (right C8T1T2 ridge nerve control area) skin pigmentation (see Figure 1), tactile pain is obvious, autologous outbreak pain 10 to 15 times / hour, VAS6 to 8 minutesAuxiliary examination: the blood clotting time and the coagulation enzyme time is normalIn view of the frequent and intense pain attacks of the patient, it was decided to first direct the advance ultrasound downward C8T1 vertebral block (0.25% ropica in a total of 5 ml), the pain immediately relieved, but the pain remained after 6 hoursThen with the family consultation, decided to line "CT guided under the right side C8T1 spinal nerve root radio frequency" treatmentThe hospital ethics committee approved and signed an informed consent form with the patient's family, preoperative fasting 4h, intravenous retention sleeve needle spare, replacement of sterile surgical clothing to instruct the patient to lie on the CT table, shoulder pad pillow, so that the head and neck hanging to the health side, with a wide plastic cloth will be the side of the shoulder to the foot pull fixed on the CT tableFigure 1 The pigmentation area after skin loss is located on the right chest back, under the right armpit, and on the right upper limb side (right C8T1T2 ridge nerve dominant zone) skinPlacement of noninvasive blood pressure, pulse oxygen saturation and electrocardiogram monitoring, nasal catheter oxygen absorption 4L/minCervical shoulder placement positioning grille, CT scan neck chest positioning image after the 1st rib center, layer thickness 3mm vertical scan C7T1 vertebrae hole, and the corresponding level design puncture path (measuring puncture depth and determine the needle point), and then in the bureau line according to the design of the puncture path into the needle, until the RF needle reaches the C7T1 intervertebral hole (see Figure 2, 3), high (50), low Hz (2Hz) frequency electrophysiological test 0.5mA the former can induce the original pain region hemorrine, the latter can induce the original pain area muscle pumping, intravenous propofol 50 mg, the patient fell asleep after the T1 spinal nerve root for radiofrequency coagulation damage (95 degrees C, 300s), and then c8 nerve root (located in the C7 vertebrae hole) for a long-range pulse radio frequency (42 degrees C, 600s)During the monitoring showed that the patient's vital signs were normal, after the patient woke up, the needle jabs under the armpits and chest skin damage area felt reduced, the tentacles induced pain disappeared, the pain of self-complaint reduced by 80%, VAS1 to 2 pointsStop using Gaba spentine and Primin, observing that the pain does not worsen for 3 daysIn March, the patient did not need to take any analgesics and was very satisfied with the RF treatmentfigure 2 C8 spinal nerve root radio frequencyfigure 3 T1 spinal nerve root radio frequencyfigure 4 T1 intervertebral hole is blocked by vertebral plate and rib-cross-breakjoint joint, making the classic tilt side side side operation is very difficult, the use of bent needle technology to barely complete rfave treatment2Discussafter herpes is a common sequelae of patients with the old ageAt present, it is believed that the cause of its occurrence is chickenpox-striped herpes virus destroys the nerve envelope, thus forming peripheral sensitivity and pain allergy, coupled with the change of neurocenter plasticity leading to central sensitization and the formation of spontaneous painIn the acute stage of herpes, nerve blocking can not only effectively analgesic, but also effectively reduce the occurrence of residual nerve painOur earlier studies have found that CT-guided lower spinal nerve backer coin radiofrequency coagulation can be effective in treating nerve pain after stubborn shingles, and we also describe the specific CT positioning-guided puncture technology - the next side of the lygdown vertebrae in the chest sectionbut for the T1 spinal nerve back root joint, because the vertebrae is small and the vertebrae plate is large, the intervertebral hole because of the vertebral plate and rib-cross-break joint blocking, making the classic reclining side side of the vertebrae into the road operation is very difficult, the use of bent needle technology to barely complete (see Figure 4), very time-consumingAnd the patient's lesions at the same time affect the neck chest spine nerve, if the use of classic puncture operation technology, need to reclining to complete the neck spine nerve root radio frequency and then re-position the chest spinal nerve root radio frequency, so that the operation is more cumbersomefor this purpose, we envisage the use of side lying operation: through the shoulder pad pillow so that the head and neck hanging to the health side, in addition to a wide rubber cloth to the affected side shoulder to the foot side fixed to the CT table, so that the surgical field can have good exposure, and the end of the patient's chest also moved down, so that the puncture path does not have to go through the chest cavity, to avoid puncture caused by the gas chest provides a basic guaranteeIn this case, the pain area of patients is mainly located in the right C8T1, in order to avoid damage to the C8 ridge nerve caused by the corresponding motor function damage, we took the c8 long-range pulse radio frequency, and the T1 ridge nerve root without upper limb motion function, the use of radio frequency thermal coagulation damage, in line with the serial treatment strategy of nerve pain after shinglesFrom the course and results of the radiofrequency therapy of patients in this case, it is a good choice to use the radiofrequency therapy of the lower spinal nerve root guided by the crony lysin CT to patients with persistent nerve pain after shingles and rheumatism that simultaneously affect the nerves of the neck and chest