Clinical and Radiological Comparisons of Percutaneous Low-Power Laser Discectomy and Low-Temperature Plasma Radiofrequency Ablation for Cervical Radiculopathy: A Prospective, Multicenter, Cohort Study

Abstract

BackgroundMinimally invasive techniques, such as percutaneous low-power laser discectomy (PLLD) and low-temperature plasma radiofrequency ablation (coblation) can be applied to treat degenerative cervical radiculopathy. However, less evidence supports the superiority of distinct minimally-invasive therapy. Our study aimed to evaluate the clinical and radiological characteristics of the PLLD and coblation for cervical radiculopathy.MethodsThis was a prospective, multicenter, cohort study (ChiCTR-ONC-17010356). The modified Macnab criteria was performed to assess the clinical improvement pre- and post-surgery. To evaluate the radiological effect, the Pfirrmann grading system and disk herniation index were applied with MRI.ResultsIn this study, 28 patients were enrolled in the coblation group and 30 patients in the PLLD group. The mean good-excellent rate at 3-month follow-up was 82.1% for PLLD group, and 66.7% for coblation group, respectively (p = 0.179). The PLLD group achieved higher good-excellent rate 6 and 12 months after discharge (92.9 vs. 70.0%, p = 0.026). Radiological data revealed that PLLD but not coblation treatment achieved significant reduction of disk herniation index (p < 0.0001). Coblation treatment did not change the Pfirrmann grades of cervical radiculopathy patients (n = 18), and 7 out of 17 (41.2%) patients achieved improvement after PLLD therapy. None obvious adverse event was observed in this study.ConclusionBoth PLLD and coblation are effective and safe option for patients with cervical radiculopathy. Better long-term clinical outcomes may be potentially associated with the improvement of disk degeneration after PLLD treatment.

Feasibility study of ultrasound-guided percutaneous laser discectomy for cervical radicular pain

“…Consistent with previous data, we found that PLD treatment achieved significant pain relief and functional improvement for cervical discogenic pain 9 – 11 , 15 . The overall successful rate reported by previous studies ranged from 75 to 82% according to the Macnab Criteria 11 , 15 , similarly, we found that the good-to-excellent ratio gradually increased from 67% (1-month follow-up) to 89% at last interview (Fig. 6 c).…”

“…However, it remains unclear the role of discography in PLD. Thus, discography is not routinely performed before surgery according to the guideline in our center 15 . Patient was required not to drink or eat on the day of procedure, and sedative drug is administrated during the surgery if needed.…”

Ultrasound-guided percutaneous laser cervical discectomy for intractable hiccups: A rare case report

“…The conservative therapy remains the first option for cervical spondylosis, and surgical intervention can be considered for those with moderate to severe myelopathy [ 10 ]. Recently, we have demonstrated that percutaneous laser cervical discectomy achieved enduring relief for radicular symptoms caused by the cervical disc degenerative disease [ 4 ]. In this case, the patient did not present typical radiculopathy, which indicated that the cervical nerve root may be not involved with the development of the intractable hiccups.…”

“…Moreover, the puncturing access can be designed to avoid the injury of vital vessels, including vertebral artery, internal jugular vein, and carotid artery. In our center, this minimally invasive surgery is usually performed under local anesthesia with slight sedative, to prevent the potential spinal cord injury during laser ablation [ 4 ]. For this patient, we chose general anesthesia to block the persistent hiccup condition, so that we can perform percutaneous puncture in the anterior region of neck.…”

“…The detail of surgery was described as previously, Ref. [ 4 ] the patient was placed in a supine position under general anesthesia with intubation. The total duration of procedure was about one and half hour.…”