Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Via A di Rudinì 8, 20142, Milan, Italy.
Radiology Department, Sant'Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy.
Radiol Med. 2020 Jun;125(6):569-577. doi: 10.1007/s11547-020-01133-x. Epub 2020 Feb 10.
To compare clinical success and patient satisfaction of percutaneous cervical nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation treatment.
We retrospectively identified 50 consecutive patients in our institution: 24 underwent the PCD treatment and 26 patients were treated by the PCN procedure. All patients complained of radicular pain with or without neck pain; diagnosis of contained cervical disc herniation was obtained by MRI; all patients had received conservative therapy which did not result in symptom improvement. Exclusion from our series consisted of patients who had undergone previous surgery at the indicated level, or those with myelopathy, or those in whom more than a sole herniation was treated in the same session. Overall procedure time, fluoroscopy time, radiation dose and complications were recorded. The MacNab scale score was used to assess clinical success in terms of pain relief at 2- and 6-month follow-up. After 4-6 months, a cervical MRI was obtained in 24 patients.
Neither major nor minor complications were reported. Regarding patient satisfaction, overall median modified MacNab score was excellent both at 2 and 6 months after treatment. No significant statistical difference was found in mean modified MacNab score at 2 and 6 months among patients grouped by treatment choice (p = 0.319 and 0.847, respectively); radiation dose was inferior in PCN group than in PCD, with no significant statistical difference.
PCD and PCN were found to be safe and effective in terms of pain relief in contained cervical herniation treatment.
比较经皮颈椎间盘切除术（PCD）和经皮颈椎间盘髓核成形术（PCN）治疗局限型颈椎间盘突出症的临床疗效和患者满意度。
我们回顾性分析了我院 50 例连续患者：24 例行 PCD 治疗，26 例行 PCN 治疗。所有患者均主诉神经根性疼痛，伴或不伴有颈部疼痛；通过 MRI 诊断为局限型颈椎间盘突出症；所有患者均接受过保守治疗，但症状无改善。排除标准包括：治疗节段有既往手术史、存在脊髓病、在同一节段治疗超过一个突出的患者。记录总手术时间、透视时间、辐射剂量和并发症。采用 MacNab 量表评估 2 个月和 6 个月随访时的疼痛缓解情况，评估临床疗效。4-6 个月后，对 24 例患者行颈椎 MRI 检查。
无重大或轻微并发症发生。患者满意度方面，治疗后 2 个月和 6 个月时，整体改良 MacNab 评分中位数均为优秀。治疗方式分组后，2 个月和 6 个月时改良 MacNab 评分的平均评分无显著统计学差异（分别为 p=0.319 和 0.847）；PCN 组的辐射剂量低于 PCD 组，但无显著统计学差异。
PCD 和 PCN 治疗局限型颈椎间盘突出症在缓解疼痛方面均安全有效。
