Evaluation of the Diagnostic Value of Ultrasound-guided Radicular Provocation Test in Identifying Responsible Lesions in Cervical Radiculopathy
Authors: 盛 天亮 , 魏 六月 , 邓 辛 , 跑 必须 , 辽 崔林 , 张 胡安 , 邱 盛 
Published: December 2024

Background
Accurately identifying responsible lesions in multi-segmental cervical radiculopathy is challenging due to the lack of reliable diagnostic methods. While selective nerve root block (SNRB) is commonly used, its specificity remains suboptimal.
Objective
This study aims to evaluate the clinical diagnostic value of the ultrasound-guided radicular provocation test (US-guided RPT) in localizing responsible lesions in multi-segmental cervical radiculopathy.
Methods
This study included patients diagnosed with cervical radiculopathy (with unclear responsible lesions) who visited the Department of Pain Medicine at the First Affiliated Hospital of GanNan Medical University between December 2023 and August 2024. All patients underwent US-guided RPT for suspected lesions before surgery. The pain intensity [Visual Analog Scale (VAS) score] of the original symptoms at the site of pain provoked during US-guided RPT was recorded. Based on US-guided RPT results, patients received single-segment computed tomography (CT)-guided percutaneous endoscopic cervical foraminoplasty (CT-guided PECF). Postoperative follow-up assessed pain relief and functional improvement, with ≥ 50% improvement in pain symptoms (VAS score) at 3 days post-surgery used as the standard for surgical effectiveness. Lesions confirmed to be responsible based on effective pain relief were considered responsible lesions, while other suspected lesions were deemed non-responsible. By analyzing the provocation data of responsible and non-responsible lesions obtained from US-guided RPT and correlating these findings with clinical outcomes, a receiver operating characteristic (ROC) curve was generated to determine the area under the curve (AUC) and the optimal cutoff value. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of US-guided RPT were then calculated.
Results
A total of 56 patients (114 US-guided RPT procedures) with cervical radiculopathy meeting the inclusion criteria were included in this study. ROC analysis yielded an AUC of 0.874. A pain intensity ≥ 60% at the original symptom site was identified as the optimal cutoff, with sensitivity of 91.1%, specificity of 75.9%, accuracy of 83.3%, PPV of 78.5%, and NPV of 89.8%. Pain intensity at responsible lesions [6 (5, 7.75)] was significantly higher than at non-responsible lesions [0 (0, 3.25)] (P < 0.0001). Postoperative VAS scores significantly decreased from 6.59 ± 1.11 preoperatively to 1.57 ± 1.20 at 3 days, 0.59 ± 0.65 at 1 month, and 0.38 ± 0.62 at 3 months. Neck Disability Index (NDI) scores similarly improved from 27.86 ± 2.05 preoperatively to 11.34 ± 1.87 at 3 days, 4.38 ± 1.21 at 1 month, and 1.43 ± 1.29 at 3 months.
Conclusions
US-guided RPT demonstrates diagnostic value in identifying responsible lesions in multi-segmental suspected lesions of cervical radiculopathy. Additionally, following the diagnosis of responsible lesions by US-guided RPT, patients with multi-segmental cervical radiculopathy showed high efficacy when treated with CT-guided PECF.