Ultrasound-guided hydrodissection combined with radiofrequency for refractory occipital neuralgia: clinical outcomes, durability, and factors associated with repeat intervention
TL;DR
In this retrospective single-arm cohort, ultrasound-guided hydrodissection combined with radiofrequency treatment was associated with improvements in pain, headache-related disability, and depressive symptoms, together with high patient satisfaction.
Abstract
Objective To evaluate clinical outcomes after ultrasound-guided hydrodissection combined with radiofrequency treatment for occipital neuralgia secondary to greater occipital nerve (GON) entrapment and to explore factors independently associated with repeat intervention. Methods We retrospectively reviewed 81 patients with GON entrapment who underwent ultrasound-guided hydrodissection combined with radiofrequency treatment at Beijing Chaoyang Hospital between February 2024 and June 2025. The mean follow-up was 12.39 months. Pain intensity, headache-related disability, and depressive symptoms were assessed preoperatively and 3 months after treatment using the Visual Analogue Scale (VAS), Migraine Disability Assessment (MIDAS), and 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), respectively. Kaplan–Meier analysis was used to estimate the median duration of symptom relief. Multivariable logistic regression was performed to identify factors independently associated with repeat intervention. Receiver operating characteristic analysis was used to determine an optimal cutoff, and subgroup analyses were conducted to assess the consistency of the association. Results At 3 months, the mean VAS score decreased from 6.56 ± 1.63 preoperatively to 1.88 ± 1.05, MIDAS grades improved significantly, and the mean CESD-10 score decreased from 12.41 ± 7.26 to 7.63 ± 5.14 (all p < 0.05). The proportion of patients satisfied with treatment was 87.7%. One patient experienced local anesthetic systemic toxicity, corresponding to a complication rate of 1.23%. The median duration of symptom relief was 6 months. Multivariable logistic regression identified age as independently associated with repeat intervention (OR, 0.947; p = 0.022), with an optimal cutoff of 56.5 years. The inverse association between age and repeat intervention was generally consistent across prespecified subgroups, with no statistically significant interactions (all P for interaction > 0.05). Conclusion In this retrospective single-arm cohort, ultrasound-guided hydrodissection combined with radiofrequency treatment was associated with improvements in pain, headache-related disability, and depressive symptoms, together with high patient satisfaction. Older age was independently associated with a lower likelihood of repeat intervention.