Interventional pain therapy in cervical post-surgery syndrome

Abstract

Fifteen percent to forty percent of patients present with persistent disabling neck pain or radicular pain after cervical spine surgery. Persistent pain after cervical surgery is called cervical post-surgery syndrome (CPSS). This review investigates the literature about interventional pain therapy for these patients. Because different interventions with different anatomical targets exist, it is important to find the possible pain source. There has to be a distinction between radicular symptoms (radicular pain or radiculopathy) or axial pain (neck pain) and between persistent pain and a new onset of pain after surgery. In the case of radicular symptoms, inadequate decompression or nerve root adherence because of perineural scarring are possible pain causes. Multiple structures in the cervical spine are able to cause neck pain. Hereby, the type of surgery and also the number of segments treated is relevant. After fusion surgery, the so-called adjacent level syndrome is a possible pain source. After arthroplasty, the load of the facet joints in the index segment increases and can cause pain. Further, degenerative alterations progress. In general, two fundamentally different therapeutic approaches for interventional pain therapy for the cervical spine exist: Treatment of facet joint pain with radiofrequency denervation or facet nerve blocks, and epidural injections either via a transforaminal or via an interlaminar approach. The literature about interventions in CPSS is limited to single studies with a small number of patients. However, some evidence exists for these procedures. Interventional pain therapies are eligible as a target-specific therapy option. However, the risk of theses procedures (especially transforaminal epidural injections) must be weighed against the benefit.

Keywords: Post-surgery syndrome, Neck pain, Cervical epidural injections, Cervical interlaminar injections, Cervical transforaminal injections, Cervical facet joint pain, Cervical radiofrequency neurotomy, Facet joint nerve block, Epidural steroids, Local anesthetics

Core tip: This review investigates the evidence for interventional pain therapy treatments for patients with cervical post-surgery syndrome. Persistent pain after cervical surgery is a common problem. Interventional therapies are specific therapy options which are well investigated for patients with neck pain and radicular symptoms. Unfortunately, only single studies for patients with post-surgery syndrome exist. These studies, the different approaches (radiofrequency, facet joint nerve blocks, transforaminal and interlaminar epidural injections), and pain sources for patients after cervical surgery are discussed.