An Imaging Study to Evaluate Risk Factors with the Effectiveness of Cervical Epidurals in the Management of Neck anti Shoulder Pain in a Young Population

探討肩頸痛在年輕群組的風險因素以及硬膜外注射的有效性

葵佳勳(Isao Aoi) ； 戴裕庭(Yu-Ting Tai) ； 陳煥杰(Huan-Chieh Chen) ； 雷大雅(Tai-Ngar Lui) ； 林天仁(Tien-Jen Lin)

《疼痛醫學雜誌》 27卷2期 (2017/09) Pp. 53-61

摘要

Background: Neck and shoulder pain (NSP) is a common complaint in the general population, and it often causes remarkable personal suffering due to pain, disability, and impaired quality of life. The natural course of NSP is not well documented, but the onset of symptoms often takes place at a young age. Objective: This study was to evaluate risk factors of NSP populations under 40-year- old and which might be possibly associated with structural changes of the cervical spine detected by cervical curvature measurements, magnetic resonance imaging (MRI). A 12-month follow-up survey of the same sample after cervical epidurals in the initial management of their chronic neck pain. Materials and Methods: This study comprised three parts: a cross-sectional survey of young patients (n=39) with NSP under cervical epidural treatment, an one-year follow-up survey of the same sample, cervical curvature measurements and a MRI study of a subgroup (n = 31) of the follow-up population. Results: In the MRI study, frequency of pathological changes of the cervical spine was equally common as that of the normal images in cervical MRI of symptomatic young subjects. Kyphotic cervical curve is measured in young adults with NSP. Female affected subjects with NSP are prone to be cervically kyphotic in this present study. Our retrospective study of cervical epidural treatment does demonstrate a statistically significant improvement in VAS pain scores and functional status in this group of patients. Conclusion: The results have been congruent in that demographic factors have a significant role in the development of NSP even in young populations. Based on our results, some recommendations can be given to clinicians, a radiologic evaluation might be useful addition to the physical examination. Instead, MRI is rarely helpful on diagnosing and making decisions on the treatment ofyoung adults with NSP.

關鍵字

Cervical epidural ； Neck and shoulder pain ； Risks ； Young population

並列摘要

背景：肩頸痛是大眾常抱怨的主訴，而也會影響生活品質。肩頸痛的致病機制未被證實。但發病時機以年輕時開始，而過去十年這群病患數目不斷的上升。目標：評估40歲以下的年輕群組罹患肩頸痛的風險因素，經由磁振造影與X光頸椎曲度來評估此疾病與頸椎結構變化有顯著相關性。除此，也針對施行硬膜外注射的亞群族病患進行了12個月追蹤。方法：（1）横斷式研究年輕群組罹患肩頸痛而經由硬膜外注射治療，（2）同一群組於治療後一年的追蹤觀察，（3）獲取此群組的頸椎曲度以及磁振造影的結構數據資料。結果：肩頸痛群組的磁振造影檢查發現病理變化發生並無應對上的提高，頸椎後突於女性年輕群組的肩頸痛有顯著的因果關係。12個月後回顧性分析研究顯示接受過硬膜外注射的病患，疼痛指數及功能有得到顯著的改善。結論：我們建議在評估年輕群組的肩頸痛時，除了進行理學檢查之外，也可安排頸椎X光影像學檢查，測量頸椎曲度。磁振造影檢査在此群組用來診斷肩頸痛幫忙有限。

並列關鍵字

風險因素 ； 肩頸痛 ； 頸椎硬膜外注射 ； 年輕群組