Percutaneous Laser Disc Decompression Treatment for Cervical Spondylopathy
|School||Tianjin Medical University|
|Keywords||Cervical Spondylopathy Intervertebral disk PLDD Laser Cervical vertigo|
Objective: Cervical spondylopathy is a kind of regular and frequently encountered disease in clinic. Its pathology basically is degenerative change of disc intervertebrales. Percutaneous laser Disc Decompression treatment is one of Minimally Invasive Surgeries which has been developed more often recently, with the advantages of Minimal Invasion, short term of recovery, less cost requested etc. however, due to the difference of detailed medical techniques and procedure in every hospital in China or abroad, different armamentarium applied for laser treatment, choose of intervertebral disc during treatment, different laser radioactivity value control, especially divergence idea exists for adaptive diseases and contraindicates, there is no an universal and approved standard for clinic estimate so far, accordingly the result of treatment are differently considered and hard to study. So it is necessary to make an objective appraisal for the clinic worth of PLDD, improve the standard of technical procedure of PLDD, have a further discussion for adaptive diseases and contraindicates and measurement, in order to develop a reasonable program of clinic diagnosis and treatment.Methods: Concerned information was collected from the case history of cervical spondylopathy patients who had taken the treatment of PLDD in our hospital, all histories are intact, totally 527 cases had been followed-up. Male 276, female 251, age range: 36-84, average age is 56.8. Course of disease are 3days-12years, average disease course is 8.5 months. Followed-up periods are 3-36months, average period is 14.5 months. 195 were of nerve root type, 205 were of spine cord type, 127 were of vertebra artery type and sympathesis type. 1021 disci intervertebrales were treated at all, among them, C3～4 187 cases, C4～5 337 cases, C5～6 438 cases, C6～7 59 cases. Surgery section statistic: 239 cases of 1 section, 185 cases of 2 sections, 97 cases of 3 sections, 6 cases of 4 sections. Applied armamentarium: 980nm wavelength semiconductor laser equipment, impulse project energy 5J/S, general energy 100-500J/D.527 cases has been divided into 2 groups, 340 cases were from 2004-2006 and are considered to be in the traditional group, through reviewing and analyzing the histories of these cases, we studied the clinic experience of this treatment and made improvement many times: （l）single section laser capacity was reduced from 200-500J to 100-200J. （2）selecting PLDD cases more rigidly, excluding straitness of Cervical spinal canal; iconography Pearce level isⅣ、Ⅴ, medium or more straitness sufferer between disci intervertebrales; with a Hasegawa IV degree and MRI shows fibrous ring breaks, nuclei gelatinosus prolapsed patient; horizontal shift distance between neighbor centra is more than 3.5 mm or an enlarged angle which is bigger than 11, obvious unsteadiness of cervical spondylopathy, OPLL sufferers. A new PLDD clinic diagnose and treatment program was established and completed by the improving mentioned above, according to which we proceeded with 187 cases from 2007-2008, and these patients will be the improved group. Here is the conclusion after comparation and analysis between these two groups.Results:No obvious difference could be found from the gender of these 2 groups （χ2 =1.598, p > 0.05）, age （t = 1.849, p > 0.05）, clinical classification（χ2 = 0.623, p > 0.05）, Preoperative clinical symptom （χ2 = 2.977, p > 0.05）. comparing by the results of treatment within traditional group: the results of patients without disci intervertebrales straitness are better than disci intervertebrales straitness sufferers （χ2 = 10.229, p < 0.05）, the results of those who had no unsteadiness of cervical spondylopathy are better than the results of those who had unsteadiness of cervical spondylopathy （χ2 = 14.880, p < 0.05）, results of no OPLL patients are better than those OPLL sufferers （χ2= 4.125, p < 0.05）, different iconography Pearce levels lead to a obviously different curative effect, and the cured rate is obviously lowered down for each level（P < 0.05）, curative effect of different MRI Hasegawa typing are of an important statistic meaning（P < 0.05）, cured rate is gradually lowered down with MRI level going up.For the cervical spondylopathy of nerve root type, by the JOA grading, the improved rate for Preoperative patients and postoperative patients are 66.45 % and 71.45 %, comparing Preoperative patients and postoperative patients（t = 19.599、t = 2.100, P < 0.05）. comparing Preoperative patients and postoperative patients by VAS ache vision simulation grading（t = 4.327、t = 5.316, P < 0.05）. In other words, for both traditional group and improved group, curative effects are obviously improved for both Preoperative and postoperative. Comparing the Preoperative and postoperative with both groups, the result shows: （t = 0.353、t = 0.856 , P > 0.05）, no matter Preoperative and postoperative, no obvious statistic meaning from the JOA grading between two groups.Estimating the spinal cord cervical spondylopathy according JOA 17, no obvious statistic meaning with the JOA grading for the Preoperative of both groups （t = 0.622, P > 0.05）, however, the grading of postoperative, the improved group is obvious higher than the traditional group（t = 6.119, P < 0.05）. Estimate the curative effect of postoperative vertebra artery patients by Nagaseima measuring standard, the good rate for two groups are 79.73 % and 84.44 %, probably no any statistic meaning with it（χ2 = 2.961, P > 0.05）.different laser radioactivity projecting value shows no obvious statistic meaning comparing 100-200J group and 200-500J group（χ2 = 0.012, P > 0.05）.satisfaction rate of postoperative patients: 92.82 % for nerve root type; 86.34 % of spinal cord type, 89.76 % of vertebra artery.Integrated estimated by Macnab measurement, good rate of improved group （86.63 %） is absolutely higher than traditional group（73.24 %）, （χ2 = 12.611, P < 0.05）. the overall living quality estimating by SF-36, for both traditional group and improved group, SF-36 estimating result of the followed-up investigated postoperative patients is obviously higher than the preoperative patients,（ t = 17.706、20.415, P < 0.05）, no obvious statistic difference can be found with the SF-36 estimating result of preoperative,（ t = 1.950, P > 0.05）, however, SF-36 estimating result of followed-up postoperative of improved group is obviously better than traditional group,（ t = 6.539, P < 0.05）.Conclusion:（1） PLDD is an effective way of curing cervical spondylopathy, it could be one of the important step in the whole treatment of cervical spondylopathy.（2） PLDD is going with the advantages of safety, minimal Invasion and pain, short term of recovery, less cost requested and less days in hospital etc.（3） PLDD can bring the best curative effect for cervical spondylopathy of the nerve root type, a comparatively better curative effect for cervical stunning symptom which caused by vertebra artery type and sympathesis type of cervical spondylopathy. adaptive diseases includes: definite patient who is diagnosed through iconography combining with physical symptom; the patients who get no improvement by reserved treatment; and the patients who are not willing to take a surgery treatment and requiring a PLDD treatment.（4） Contraindicates of PLDD includes: straitness of Cervical spinal canal; iconography Pearce level isⅣ、Ⅴ, medium or more straitness sufferer between disci intervertebrales; with a Hasegawa IV degree and MRI shows fibrous ring breaks, nuclei gelatinosus prolapsed patient; horizontal shift distance between neighbor centra is more than 3.5 mm or an enlarged angle which is bigger than 110, obvious unsteadiness of cervical spondylopathy, OPLL sufferers, bleeding tendency or severe cardiovascular or cerebrovascular disease sufferer.（5） Lower down the radiation capacity of the single section laser will not lower down the curative effect, however, this it may reduce untoward effect efficiently. It is suggested that set the project power to 5 W/S during the PLDD treatment for cervical spondylopathy, the total power finally would be 100-200J, cooling down will be needed by minus-pressure pumping with tri-cavity normal saline for each 50J period.