RESUMEN
OBJECTIVE: To evaluate the feasibility and efficacy of computed tomography (CT)-guided radiofrequency ablation (RFA) of cervical intervertebral discs for the treatment of discogenic cervicogenic headache (CEH). BACKGROUND: Some patients with CEH experience no obvious therapeutic effect after conventional therapy, particularly patients with refractory CEH originating from abnormal cervical intervertebral discs. Treatment for this type of CEH remains poorly characterized. METHODS: Using a single intervention arm, pretest/posttest design, we retrospectively analyzed the data of patients who underwent CT-guided RFA of cervical intervertebral discs for CEH at the Pain Medicine Center of Zhejiang Provincial People's Hospital from January 2017 to April 2021. If conservative treatment failed in patients with discogenic CEH, we classified the patients as having refractory CEH and performed RFA of cervical intervertebral discs. We used a numeric rating scale (NRS) to assess pain intensity for 6 months. We also compared therapeutic outcome of patients with different characteristics. RESULTS: A total of 44 patients who underwent CT-guided RFA of cervical intervertebral discs were enrolled and 41 of them were analyzed in the present study. The preoperative median (25th, 75th) NRS score was 4 (4, 5), and it was significantly reduced to 1 (0, 4) 6 months after RFA (p < 0.001). The number of patients with ≥50% of their pain relieved after 6 months was 28 of 41 (68%). No serious treatment-related complications occurred in this study. Compared with single-level RFA, multi-level RFA shows greater effects on pain intensity reduction (p = 0.032) and pain relief rate (p = 0.047) of patients. CONCLUSION: In patients who have discogenic CEH, CT-guided RFA of the cervical intervertebral discs appears to be a promising treatment with no serious complications.
Asunto(s)
Ablación por Catéter , Trastornos de Cefalalgia , Disco Intervertebral , Cefalea Postraumática , Trastornos de Cefalalgia/complicaciones , Humanos , Disco Intervertebral/diagnóstico por imagen , Disco Intervertebral/cirugía , Dolor/complicaciones , Cefalea Postraumática/diagnóstico por imagen , Cefalea Postraumática/etiología , Cefalea Postraumática/cirugía , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The present study aimed to investigate the function and possible underlying mechanism of various concentrations of visceral adipose tissuederived serine protease inhibitor (vaspin) on leptininduced inflammatory and metabolic responses in rat chondrocytes. Rat articular chondrocytes were isolated and treated with different concentrations of vaspin, which was followed by stimulation with leptin. The expression of genes, secretion of nitric oxide and tumor necrosis factorα, and activation of the nuclear factor (NF)κB pathway were analyzed by reverse transcriptionquantitative polymerase chain reaction, ELISA and western blotting. The results demonstrated that vaspin inhibited the leptininduced upregulated gene expression levels of leptin receptor (OBRb), a disintegrin and metalloprotease with thrombospondin motifs (ADAMTS)4, ADAMTS5, matrix metalloproteinase (MMP)2 and MMP9, and the secretion of NO and TNFα, in a dosedependent manner. The phosphorylation of inhibitor of NFκB (IκB), IκB kinase (IKK)α, IKKß and NFκB were also promoted by leptin in the chondrocytes, which were also suppressed by increased concentration of vaspin. Taken together, results demonstrated that vaspin prevented leptininduced inflammation and catabolism by inhibiting the activation of NFκB in rat chondrocytes.