A Multimodal Interventional Approach for Chronic Refractory Neck and Interscapular Pain: A Case Report of Combined Intradiscal Platelet Rich Plasma Injection and Transarterial Microembolization

A Multimodal Interventional Approach for Chronic Refractory Neck and Interscapular Pain: A Case Report of Combined Intradiscal Platelet Rich Plasma Injection and Transarterial Microembolization

Chronic neck and interscapular pain presents both a diagnostic and therapeutic challenge, often involving overlapping pain generators such as cervical discs, facet joints, nerve roots, and myofascial structures. This report describes a 46-year-old woman with systemic lupus erythematosus and a one-year history of persistent neck and interscapular pain unresponsive to conventional therapies, including non-steroid antiinflammatory drugs (NSAIDs) and shockwave therapy. Magnetic resonance imaging revealed multilevel cervical disc protrusions. Initial ultrasound-guided trigger point injections and nerve hydrodissection provided only temporary relief. Diagnostic confirmation of discogenic pain was achieved via symptom provocation during ultrasound- and fl uoroscopy-guided intradiscal platelet-rich plasma (PRP) injections into the C4–5 and C5–6 discs, resulting in marked improvement in neck and left trapezius pain. However, right interscapular pain persisted. Transarterial microembolization (TAME) targeting the suprascapular, transverse cervical, and circumflex scapular arteries led to successful symptom reproduction during the procedure and subsequent sustained pain reduction. This case highlights the utility of combining diagnostic precision and multimodal interventions—PRP for discogenic pain and TAME for refractory myofascial pain—in managing complex, chronic cervical pain syndromes. Further research is needed to validate the long-term effi cacy and safety of such individualized strategies.