Kong Shuyi, Qian Xuantao, Cai Jianfeng, Wang Jing, Wang Kaiqiang
Department of Pain Management, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China.
Shu Guang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China.
Biomed Rep. 2024 Aug 22;21(5):152. doi: 10.3892/br.2024.1840. eCollection 2024 Nov.
Cervical spondylotic radiculopathy (CSR) is the most common type of cervical spondylosis, frequently accompanied by cervicogenic headache (CEH). Percutaneous plasma disc decompression (PPDD) and pulsed radiofrequency (PRF) are minimally invasive techniques targeting cervical intervertebral discs or cervical nerves, and have been proven to be effective methods for treatment of CSR and CEH. The present study aimed to evaluate clinical efficacy and practicality of percutaneous plasma disc decompression (PPDD) via a lower surgical approach for the treatment of cervicogenic headache (CEH) and upper extremity radicular pain by analyzing clinical outcomes of patients with cervical spondylotic radiculopathy (CSR) undergoing PPDD and pulsed radiofrequency (PRF). Clinical data of patients with CSR who received PPDD (n=79) or PRF (n=92) at Shanghai Traditional Chinese Medicine Hospital (Shanghai, China) and Jiashan County People's Hospital (Jiaxing, China) from January 2022 to December 2022 were retrospectively collected and analyzed. The surgical site and procedure, bleeding volume, preoperative analgesic use and upper extremity symptoms, history of nerve block treatment and duration of disease were recorded, as well as relevant postoperative complications (infection, hematoma, nerve injury). The therapeutic effects [NRS (numeric rating scale) and NDI (neck disability index) score, and CEH remission rate at 1, 3 and 6 months after treatment] of both surgical methods were investigated using the telephone follow-up. CEH remission rates at 1, 3 and 6 months after surgery in the PPDD group were significantly higher than in the PRF group (78.8 vs. 43.5, P=0.016; 84.8 vs. 34.8, P=0.003 and 75.8 vs. 26.1%, P=0.005, respectively). The PPDD group showed higher NRS scores than the PRF group at 1 month after surgery (3 vs. 2, P<0.0001) and lower NRS scores than the PRF group at 6 months after surgery (2 vs. 3, P<0.0001). NDI scores in the PPDD group were significantly lower than those in the PRF group at 1, 3 and 6 months after surgery (15.49 vs. 20.05, P=0.002; 16.06 vs. 20.10, P=0.003 and 9.90 vs. 13.80, P=0.001, respectively). There was no significant difference in postoperative complication rate between the two groups (P>0.999). PPDD could significantly relieve CEH symptoms and upper extremity radicular pain in patients with CSR treated via a lower surgical approach and PPDD was more effective than PRF for long-term CEH remission and pain alleviation.
神经根型颈椎病（CSR）是颈椎病最常见的类型，常伴有颈源性头痛（CEH）。经皮等离子椎间盘减压术（PPDD）和脉冲射频（PRF）是针对颈椎间盘或颈神经的微创技术，已被证明是治疗CSR和CEH的有效方法。本研究旨在通过分析接受PPDD和脉冲射频（PRF）治疗的神经根型颈椎病（CSR）患者的临床结局，评估经下手术入路的经皮等离子椎间盘减压术（PPDD）治疗颈源性头痛（CEH）和上肢根性疼痛的临床疗效和实用性。回顾性收集并分析了2022年1月至2022年12月在上海中医药大学附属龙华医院（中国上海）和嘉善县人民医院（中国嘉兴）接受PPDD（n = 79）或PRF（n = 92）治疗的CSR患者的临床资料。记录手术部位和操作、出血量、术前镇痛药物使用情况和上肢症状、神经阻滞治疗史和病程，以及相关的术后并发症（感染、血肿、神经损伤）。通过电话随访调查两种手术方法的治疗效果（数字评分量表[NRS]和颈部功能障碍指数[NDI]评分，以及治疗后1、3和6个月的CEH缓解率）。PPDD组术后1、3和6个月的CEH缓解率显著高于PRF组（分别为78.8%对43.5%，P = 0.016；84.8%对34.8%，P = 0.003；75.8%对26.1%，P = 0.005）。PPDD组术后1个月的NRS评分高于PRF组（3对2，P < 0.0001），术后6个月的NRS评分低于PRF组（2对3，P < 0.0001）。PPDD组术后1、3和6个月的NDI评分显著低于PRF组（分别为15.49对20.05，P = 0.002；16.06对20.10，P = 0.003；9.90对13.80，P = 0.001）。两组术后并发症发生率无显著差异（P > 0.999）。经下手术入路，PPDD可显著缓解CSR患者的CEH症状和上肢根性疼痛，且PPDD在长期CEH缓解和疼痛减轻方面比PRF更有效。
