Sonography-guided C2 nerve root blocks for cervicogenic headache: A prospective observational study
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Published on: September 13, 2024
Xiuhua Li1, Qingyuan Hu1, Shuyue Zheng2
1Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, No. 2, Xihuan South Road, Daxing District, Beijing 100176, China.
Background:
This study aimed to evaluate the procedural performance and safety of sonography-guided C2 nerve root blocks, with therapeutic efficacy for treating cervicogenic headache (CEH) as a secondary outcome.
Methods:
A total of 134 patients with CEH were prospectively enrolled. The sonographic technique was utilized to specify the C2 nerve root with a safety boundary, allowing for the most optimal trajectory via an obtuse angle of needle insertion to sonographic beam. Primary endpoint was the accuracy of reaching the C2 nerve root under sonographic imaging, confirmed by a liner contrast pattern on X-ray. Secondary outcomes included procedural outcomes, dermatomal sensory block scores, Numerical Rating Scale (NRS) pain scores and neck disability index (NDI).
Results:
94.4% of procedures were performed accurately under sonographic guidance. A needle that was clearly visible with high echogenicity was observed in 88.1% of procedures. All patients experienced a loss of cold-sensation within the involved dermatomes at 5 min post-block, which persisted in 69.2% of cases up to 30 min (all adjusted p < 0.001). Median number of needle insertions were 2 times and mean performance time was 8.53 min. Temporary minor adverse events occurred in 6.7% of patients. Median NRS pain scores for headache pain decreased from 8 at baseline values to 3 at 1 month and 2 at 3 months after blocks (both adjusted p < 0.001). Mean NDI scores reduced from 36.51 at baseline to 21.76 at 1 month and 12.21 at 3 months following blocks (both adjusted p < 0.001).
Conclusions:
In this cohort of patients treated by experienced operators, the proposed sonographic technique for guiding C2 nerve root blocks achieved a high procedural accuracy and was not associated with serious complications, with encouraging improvements in pain relief and function. Given the observational, single-center design and the absence of a control group, these findings should be considered preliminary and require confirmation in larger controlled trials.
