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      Ultrasound-Guided Cervical Intradiscal Injection with Platelet-Rich Plasma with Fluoroscopic Validation for the Treatment of Cervical Discogenic Pain: A Case Presentation and Technical Illustration

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          Abstract

          Chronic neck pain has a high incidence and prevalence in urban society. Cervical disc-related chronic neck pain with its referred pain is one of the most common causes. Traditionally, pain caused by a cervical disc is diagnosed by fluoroscopy-guided provocative discography. In this report, we presented a patient with chronic neck and shoulder pain and a technique of using ultrasound to guide the needle entry to the cervical discs which were suspected to be the cause of the patient’s chronic neck and shoulder pain. The needle placement was then validated by contrast fluoroscopy. The patient’s symptoms significantly improved three weeks after the procedure. In conclusion, US can serve as a good imaging guiding tool for cervical intradiscal injections.

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          Most cited references 8

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          The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults.

          Population-based, cross-sectional mailed survey. To determine the lifetime, period, and point prevalence of neck pain and its related disability among Saskatchewan adults and investigate the presence and strength of nonresponse bias. In Europe, the lifetime and point prevalence of neck pain is almost as high as the prevalence of low back pain. Similarly, chronic neck pain is highly prevalent and a common source of disability in the working-age population. However, no studies specifically have documented the prevalence of neck pain and its related disability in North America. The Saskatchewan Health and Back Pain Survey was mailed to 2184 randomly selected Saskatchewan adults aged 20-69 years. Fifty-five percent of the study population participated. The presence of nonresponse bias was investigated through logistic regression and wave analysis. The Chronic Pain Questionnaire was used to classify the severity of chronic neck pain. The age-standardized lifetime prevalence of neck pain is 66.7% (95% confidence interval, 63.8-69.5), and the point prevalence is 22.2% (95% confidence interval, 19.7-24.7). The age-standardized 6-month prevalence of low-intensity and low-disability neck pain is 39.7% (95% confidence interval, 36.7-42.7), whereas it is 10.1% (95% confidence interval, 8.2-11.9) for high-intensity and low-disability neck pain and 4.6% (95% confidence interval, 3.3-5.8) for significantly disabling neck pain. The prevalence of low-intensity and low-disability neck pain decreases with age. More women experience high-disability neck pain than men. Wave analysis suggests that the point prevalence and 6-month prevalence of high-intensity and low-disability neck pain are overestimated in this survey. This cross-sectional study shows that neck pain is highly prevalent in Saskatchewan and that it significantly disables 4.6% (95% confidence interval, 3.3-5.8) of the adult population.
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            Cervical disc degeneration and neck pain

            Cervical intervertebral disc has long been considered a common source of neck pain. However, the pain caused by the disc itself has not been clearly defined so far, and its diagnosis and treatment has always been controversial. Degenerative cervical disc has a rich supply of nerve fibers, is prone to inflammatory reactions, and is susceptible to pain that can be provoked by disc stimulation or distention, and can be eliminated by block. Overwhelming clinical evidence demonstrates that neck pain in patients with degenerative cervical radiculopathy or myelopathy can be subsided rapidly by anterior cervical surgery, further indicating that this neck pain stems from the pathology of cervical disc itself. Cervical discography is advocated as the only test that connects disease to symptoms, but the procedure remains controversial. If strict criteria and technique are maintained, discography can discriminate painful, symptomatic discs from nonpainful, asymptomatic discs. Discogenic neck pain alone without cervical disc herniation or cervical spondylosis accounts for a large proportion of chronic neck pain. For these patients who continue to have refractory neck pain and fail to respond to conservative treatment, anterior cervical fusion surgery or artificial cervical disc replacement may be a better choice, and preoperative cervical discography can guarantee the excellent surgical results. Existing basic and clinical studies have scientifically shown that cervical intervertebral disc degeneration can lead to neck pain.
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              Cervical discography: clinical implications from 12 years of experience.

              Positive pain responses provoked in an inclusive series of cervical discograms performed over a 12-year period were categorized by level and reviewed. To report the prevalence of cervical pathology over an entire series of patients, to determine whether a reproducible pattern of concordant pain could be associated with each symptomatic level identified, and to calculate the rate of complications. Cloward wrote the first articles explaining the technique of cervical discography and reported on the pain responses induced. Currently, the technique is viewed as an invaluable diagnostic tool, but it also is criticized for failing to contribute unique information beyond that available from imaging studies despite the inherent risks. A series of 173 cervical discograms performed over 12 years was examined. Pain responses provoked and recorded during discography were grouped by disc level and examined for recurring patterns. The prevalence of disc pathology was calculated. In all, 807 discs were injected, and 404 concordant pain responses (50%) were elicited. Three or more abnormal disc levels were identified in more than half of the patients. Complications developed in four patients (2.3%). No further complications were reported. Surgical treatment was indicated as viable in only 35 studies. Discography is a safe and valuable diagnostic procedure showing characteristic pain patterns that may have clinical significance. In more than half of the studies, three or more levels were identified as pain generators, suggesting that treatment decisions based on information from fewer discs injected during discography may be tenuous.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                jpr
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                20 August 2020
                2020
                : 13
                : 2125-2129
                Affiliations
                [1 ]Department of Family Medicine, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong
                [2 ]Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch , Taipei, Taiwan
                [3 ]Graduate Institute of Basic Medical Science, China Medical University , Taichung, Taiwan
                [4 ]Department of Physical Medicine and Rehabilitation, Yuanlin Christian Hospital , Changhua, Taiwan
                Author notes
                Correspondence: Chen-Yu Hung Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch , Taipei, Taiwan Email chenyu810@gmail.com
                Article
                264033
                10.2147/JPR.S264033
                7445511
                © 2020 Lam et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 3, References: 11, Pages: 5
                Funding
                Funded by: No funding;
                No funding was received.
                Categories
                Case Report

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