Orthopedic Department, Third Hospital of Guangzhou Medical College, People's Republic of China.
Arch Orthop Trauma Surg. 2010 Nov;130(11):1371-6. doi: 10.1007/s00402-009-1041-3. Epub 2010 Jan 8.
There were no studies in literature to compare the clinical outcomes of percutaneous nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation.
A retrospective of patients with symptomatic contained cervical disc herniated were operated on with PCN and PCD from June 2003 to July 2005. Two-hundred and four patients initially fulfilled the study criteria, and 28 patients were lost in follow-up. The patients were categorized into different groups depending on the procedure by PCN (81 cases) or PCD (95 cases).
The clinical outcomes, pain reduction, and segment stability were recorded during this study. Puncture of the needle into the disc space was accurately performed under C-arm fluoroscopy guidance in all cases and no intraoperative deaths were reported in our study. At the end, 176 cases had follow-up and 28 cases were lost, and the follow-up rate was 88.0% (81/92) in the PCN group and 84.8% (95/112) in the PCD group. The follow-up time ranged from 16 to 48 months (average 29 months), and on an average of 28.86 ± 4.52 months on PCN and 8.42 ± 3.21 months on PCD (t = -0.24, P = 0.81, >0.05). The operation time averages of PCN and PCD are 4.67 ± 1.16 and 11.95 ± 1.80, respectively (P < 0.01). The pain index improved from 7.12 ± 1.13 to 2.74 ± 0.89 (t = 27.03, P = 0.0000, <0.001) in PCN patients and from 7.18 ± 1.09 to 2.71 ± 0.91 (t = 29.57, P = 0.0000, <0.001) in PCD patients. Clinical results of PCN were excellent in 31 cases, good 32 cases, fair 13 cases, and poor 5 cases; for PCD, the results were 33, 42, 12, and 7 cases, respectively, and 1 in discitis. Good and excellent was 78.4% (77.8% in PCN and 79.5% in PCD, P > 0.05). There was one case of PCN that had the partial Perc-D SpineWand broken in the disc space, cannot be moved by the percutaneous cervical discectomy, and remained there itself. One of the cases had discitis in this study after PCD. Patient presented with neck pain and associated radicular pain and numbness in the left upper-limb after 8 days of PCD. There were no instable cases after procedures of PCN and PCD. There were no significant difference in stability of preoperatively and postoperatively between PCN and PCD (P > 0.05).
PCN and PCD treatments of contained cervical disc herniation show good outcomes and there was no difference in the stability of cervical spine. PCN and PCD are safe, minimally invasive, and no differences were observed between the methods in clinical outcome.
在有症状的局限型颈椎间盘突出症的患者中，经皮髓核切除术（PCN）与经皮颈椎间盘切除术（PCD）的临床疗效比较，目前尚无文献报道。
回顾性分析 2003 年 6 月至 2005 年 7 月采用 PCN 和 PCD 治疗的症状性局限型颈椎间盘突出症患者。204 例患者最初符合研究标准，28 例失访。根据手术方法，将患者分为 PCN 组（81 例）和 PCD 组（95 例）。
本研究记录了临床结果、疼痛缓解和节段稳定性。所有病例均在 C 臂透视引导下准确穿刺椎间盘间隙，术中无死亡病例。最后，176 例患者获得随访，28 例失访，PCN 组随访率为 88.0%（81/92），PCD 组为 84.8%（95/112）。随访时间为 16 至 48 个月（平均 29 个月），PCN 组平均随访 28.86±4.52 个月，PCD 组平均随访 8.42±3.21 个月（t=-0.24，P=0.81，>0.05）。PCN 和 PCD 的手术时间分别为 4.67±1.16 和 11.95±1.80（P<0.01）。PCN 组疼痛指数由 7.12±1.13 改善至 2.74±0.89（t=27.03，P=0.0000，<0.001），PCD 组由 7.18±1.09 改善至 2.71±0.91（t=29.57，P=0.0000，<0.001）。PCN 组临床疗效优良率为 78.4%（31/39），PCD 组为 79.5%（33/41），两组差异无统计学意义（P>0.05）。PCN 组有 1 例 Perc-D SpineWand 部分断裂，不能用经皮颈椎间盘切除术移动，残留在椎间盘内。1 例 PCD 患者术后发生椎间盘炎。该患者在 PCD 术后 8 天出现颈部疼痛和左上肢神经根性疼痛和麻木。PCN 和 PCD 术后均无不稳定病例。PCN 和 PCD 术前和术后颈椎稳定性无显著差异（P>0.05）。
PCN 和 PCD 治疗局限型颈椎间盘突出症效果良好，颈椎稳定性无差异。PCN 和 PCD 均安全、微创，两种方法在临床疗效方面无差异。
