Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Anesthesiology, Longyan First Hospital, Affiliated to Fujian Medical University, Longyan City, Fujian, China.
Ann Med. 2021 Dec;53(1):639-646. doi: 10.1080/07853890.2021.1910336.
Little is known about the therapeutic relationship between coblation discoplasty and cervicogenic dizziness (CGD). CGD can be caused by abnormal proprioceptive inputs from compressed nerve roots, intradiscal mechanoreceptors and nociceptors to the vestibulospinal nucleus in the degenerative cervical disc. The aim was to analyze the efficacy of coblation discoplasty in CGD through intradiscal nerve ablation and disc decompression in a 12-month follow-up retrospective study.
From 2015 to 2019, 42 CGD patients who received coblation discolplasty were recruited as the surgery group, and 22 CGD patients who rejected surgery were recruited as the conservative group. Using intent-to-treat (ITT) analysis, we retrospectively analyzed the CGD visual analogue scale (VAS), neck pain VAS, CGD frequency score, and the CGD alleviation rating throughout a 12-month follow-up period.
Compared with conservative intervention, coblation discoplasty revealed a better recovery trend with effect sizes of 1.76, 2.15, 0.92, 0.78 and 0.81 in CGD VAS, and effect sizes of 1.32, 1.54, 0.93, 0.86 and 0.76in neck pain VAS at post-operative 1 week, and 1, 3, 6, 12 months, respectively. The lower CGD frequency score indicated fewer attacks of dizziness until postoperative 3 months ( < 0.01). At post-operative 12 months, the coblation procedure showed increased satisfactory outcomes of CGD alleviation rating ( < .001, -1.00 of effect size).
Coblation discoplasty significantly improves the severity and frequency of CGD, which is important inbridging unresponsive conservative intervention and open surgery.Key messagesThere is a correlation between the degenerative cervical disc and cervicogenic dizziness (CGD).CGD can be caused by abnormal proprioceptive inputs from a compressed nerve root and intradiscal mechanoreceptors and nociceptors to the vestibulospinal nucleus in the degenerative cervical disc.Cervical coblation discoplasty can alleviate CGD through ablating intradiscal nerve endings and decompressing the nerve root.
关于低温射频消融椎间盘成形术（coblation discoplasty）与颈源性头晕（CGD）之间的治疗关系，目前知之甚少。CGD 可由受压神经根、椎间盘内机械感受器和伤害感受器向退行性颈椎间盘内的前庭脊髓核传入异常本体感觉引起。本研究旨在通过 12 个月的回顾性研究，分析椎间盘内神经消融和椎间盘减压在 CGD 中的疗效。
2015 年至 2019 年，共纳入 42 例 CGD 患者行低温射频消融椎间盘成形术（coblation discoplasty）治疗（手术组），22 例 CGD 患者拒绝手术（保守组）。采用意向治疗（ITT）分析，回顾性分析 12 个月随访期间 CGD 视觉模拟评分（VAS）、颈痛 VAS、CGD 频率评分和 CGD 缓解率。
与保守治疗相比，低温射频消融椎间盘成形术在术后 1 周、1、3、6、12 个月时，CGD VAS 分别具有 1.76、2.15、0.92、0.78 和 0.81 的效应量，颈痛 VAS 分别具有 1.32、1.54、0.93、0.86 和 0.76 的效应量，显示出更好的恢复趋势。CGD 频率评分较低，表明头晕发作次数减少，直到术后 3 个月（ < 0.01）。术后 12 个月时，低温射频消融椎间盘成形术治疗对 CGD 缓解的满意度提高（ < 0.001，效应量为-1.00）。
低温射频消融椎间盘成形术显著改善 CGD 的严重程度和频率，在对保守治疗无反应的患者和开放手术之间架起了一座桥梁。
退行性颈椎间盘与颈源性头晕（CGD）有关。CGD 可由受压神经根和椎间盘内机械感受器和伤害感受器向退行性颈椎间盘内的前庭脊髓核传入异常本体感觉引起。颈椎低温射频消融椎间盘成形术可通过消融椎间盘内神经末梢和神经根减压来缓解 CGD。
