Li Yongchao, Wu Bing, Li Mao, Pang Xiaodong, Yang Liang, Dai Chen, Peng Baogan
Department of Orthopedics, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China.
Department of Surgery, Peking University Hospital, Beijing 100034, China.
J Clin Med. 2023 Jun 30;12(13):4413. doi: 10.3390/jcm12134413.
There is little research in the literature comparing the efficacy of coblation nucleoplasty with conservative treatment in the treatment of cervical discogenic dizziness and reporting the achieved rate of minimal clinically important differences (MCID) and patient acceptable symptom state (PASS) after surgery. This retrospective study aims to explore the patient-reported outcome measures (PROM) following coblation nucleoplasty for cervical discogenic dizziness and to compare the therapeutic effect of coblation nucleoplasty with prolonged conservative treatment.
Sixty-one patients with cervical discogenic dizziness and a positive intradiscal diagnostic test eligible for single-level cervical coblation nucleoplasty were included in the study. Among these 61 patients, 40 patients underwent cervical coblation nucleoplasty, while the remaining 21 patients refused surgery and received continued conservative treatment. The primary PROMs were the intensity and frequency of dizziness and secondary PROMs were related to the neck disability index (NDI) and visual analog scale (VAS) for neck pain (VAS-neck) during a 12-month follow-up period. Moreover, the achieved rate of MCID and PASS in both groups was assessed 12 months after surgery.
Dizziness intensity, dizziness frequency, VAS-neck score, and NDI score were significantly improved from the baseline at all follow-up time points in both treatment groups, except for showing no significant improvement in dizziness frequency in the conservative treatment group at 6 and 12 months after surgery. However, at each follow-up time point, the above indexes were lower in the surgery group than in the conservative treatment group. In addition, the achieved rates for PASS and MCID in all indexes in the surgery group were significantly higher than those in the conservative treatment group at 12 months after surgery.
Cervical coblation nucleoplasty significantly improved the intensity and frequency of dizziness, neck pain, and NDI in patients with cervical discogenic dizziness, and the results were superior to those from prolonged conservative treatment. Meanwhile, cervical coblation nucleoplasty is a good choice for patients with chronic neck pain and refractory cervical discogenic dizziness who have not demonstrated the indications for open surgery and have not responded well to conservative treatment.
文献中很少有研究比较低温等离子体髓核成形术与保守治疗在治疗颈椎间盘源性眩晕方面的疗效，也鲜有报道术后达到最小临床重要差异（MCID）和患者可接受症状状态（PASS）的比率。本回顾性研究旨在探讨低温等离子体髓核成形术治疗颈椎间盘源性眩晕后患者报告的结局指标（PROM），并比较低温等离子体髓核成形术与长期保守治疗的疗效。
本研究纳入了61例颈椎间盘源性眩晕且椎间盘内诊断试验阳性、适合单节段颈椎低温等离子体髓核成形术的患者。在这61例患者中，40例接受了颈椎低温等离子体髓核成形术，其余21例拒绝手术，继续接受保守治疗。主要的PROM是眩晕的强度和频率，次要的PROM与12个月随访期内的颈部残疾指数（NDI）和颈部疼痛视觉模拟量表（VAS-颈部）有关。此外，在术后12个月评估两组的MCID和PASS达成率。
两个治疗组在所有随访时间点的眩晕强度、眩晕频率、VAS-颈部评分和NDI评分均较基线有显著改善，但保守治疗组在术后6个月和12个月时眩晕频率无显著改善。然而，在每个随访时间点，手术组的上述指标均低于保守治疗组。此外，术后12个月时，手术组所有指标的PASS和MCID达成率均显著高于保守治疗组。
颈椎低温等离子体髓核成形术显著改善了颈椎间盘源性眩晕患者的眩晕强度和频率、颈部疼痛及NDI，结果优于长期保守治疗。同时，对于慢性颈部疼痛和难治性颈椎间盘源性眩晕患者，若未表现出开放手术指征且对保守治疗反应不佳，颈椎低温等离子体髓核成形术是一个不错的选择。
