Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
School of Medicine, China Medical University, Taichung, Taiwan.
PLoS One. 2022 Dec 12;17(12):e0278883. doi: 10.1371/journal.pone.0278883. eCollection 2022.
Percutaneous cervical nucleoplasty (PCN) is a simple, safe, and effective treatment for contained cervical herniated intervertebral disc (CHIVD). However, few studies have compared the actual benefits of PCN against conservative treatment (CT), either clinically or radiographically.
The present study sought to analyze and to compare the outcomes of symptomatic contained CHIVD treated with PCN or CT.
The present study was designed as a case-control comparative study. Patients who indicated for PCN after a failed CT for more than 6 months were recruited. After the exclusion of some patients who did not meet the selection criteria of the study, we finally enrolled 71 patients treated with PCN. In addition, another 21 patients who indicated for PCN but finally chose to receive CT continuously were also enrolled and categorized as the control group. All patients completed the 6-month follow-up. Pain levels and functional outcomes were evaluated pre- and post-operatively by assessing the visual analog scale (VAS), Oswestry Disability Index (ODI), and Neck Disability Index (NDI). Radiographic images of 72 of 104 intervened segments were collected to measure disc height and other cervical spinal alignments, such as range of motion, C2-7 Cobb's angle, and C2-7 sagittal vertical axis.
Compared with the CT group, the PCN group showed significantly better outcomes on VAS, ODI, and NDI at the 1-month post-operative follow-up, which continued through at least the 6-month follow-up (P < 0.01 for VAS and P < 0.05 for ODI and NDI). The mean disc height significantly decreased, from 6.04 ± 0.85 mm to 5.76 ± 1.02 mm, 3 months after PCN treatment (P = 0.003). However, the degree of disc height decrease did not correlate with the changes of the substantial VAS improvement.
To provide therapeutic benefits for symptomatic contained CHIVD patients after an invalid CT for 6 months, PCN seems to be a better option than CT. The reduced disc heights did not alter the clinical outcomes of PCN.
经皮颈椎间盘髓核成形术（PCN）是一种简单、安全、有效的治疗方法，适用于有症状的颈椎间盘突出症（CHIVD）。然而，很少有研究比较 PCN 与保守治疗（CT）在临床或影像学上的实际效果。
本研究旨在分析和比较经皮颈椎间盘髓核成形术（PCN）与 CT 治疗有症状的颈椎间盘突出症的结果。
本研究设计为病例对照比较研究。对 CT 治疗失败超过 6 个月的患者进行 PCN 治疗。排除一些不符合研究选择标准的患者后，我们最终纳入了 71 例接受 PCN 治疗的患者。此外，我们还纳入了另外 21 例因 PCN 治疗而最终选择继续 CT 治疗的患者，并将其归类为对照组。所有患者均完成了 6 个月的随访。通过评估视觉模拟评分（VAS）、Oswestry 残疾指数（ODI）和颈部残疾指数（NDI）来评估术前和术后的疼痛水平和功能结果。收集了 104 个介入节段中的 72 个节段的影像学图像，以测量椎间盘高度和其他颈椎脊柱排列，如活动范围、C2-7 Cobb 角和 C2-7 矢状垂直轴。
与 CT 组相比，PCN 组在术后 1 个月的 VAS、ODI 和 NDI 评分上有显著更好的结果，并且至少在 6 个月的随访中持续改善（VAS 评分 P < 0.01，ODI 和 NDI 评分 P < 0.05）。PCN 治疗 3 个月后，椎间盘高度从 6.04 ± 0.85 mm 显著下降至 5.76 ± 1.02 mm（P = 0.003）。然而，椎间盘高度的下降程度与 VAS 显著改善程度无关。
对于 CT 治疗无效 6 个月的有症状的颈椎间盘突出症患者，PCN 似乎比 CT 更具治疗优势。椎间盘高度的降低并未改变 PCN 的临床效果。
