Comparison Of Disc Laser Repair System(DLRS) And Cervical Nerve Root Blocks(CNRB) In Cervical Disc Herniation With Radiculopathy

Background The estimated prevalence of cervical spondylotic radiculopathy has been described as 1.79‰ per year. The cervical disc herniation is the most common cause. Nowadays minimally invasive procedures are becoming the first choice of the patients with cervical spondylotic radiculopathy, including Disc Laser Repair System(DLRS) and Selective Cervical Nerve Root Blocks(SCNRB). DLRS is a minimally invasive procedure developed by the experts of Ivan Pavlov Medical University.Although it has been widely used in Russia, but there is still a lack of clinical researches about it.Objective We presented the design of a randomized controlled trial, studying the effectiveness and safety of DLRS versus classical CNRB in patients with cervical disc herniation with radiculopathy.Methods Our research was a prospective randomized controlled trial. 57 patients with cervical disc herniation with radiculopathy were randomized into two groups according to the inclusion and exclusion criteria. Group DLRS(N=28) received a puncture to the target disc under the guidance of C-shaped arm machine after local anesthesia, then an optical fiber(200μm) was placed into the center of the disc. A diode laser with a wavelength of 970 nm was used. After a small amount of energy(about 45~60J) had been used, we injected some saline into this section of cervical intervertebral disc(about 0.5~2ml). The energy shouldn’t exceed 300 J per disc, and600 J at most. Group CNRB received a puncture to the target segment of nerve roots under the guidance of C-shaped arm machine after local anesthesia. With confirmed by the contrast agent injection, 5ml of 0.8% lidocaine solution was injected to finish the nerve root blocks. The primary measurements were the Visual Analogue Score(VAS) and the Neck Disability Index(NDI). The secondary outcomes were the36-Item Short Form Health Survey(SF-36), the Patient Satisfaction Scale(PSS),length of hospital stay, the total cost of hospitalization and the complications, such as discitis(infection or aseptic), radiculitis, hematoma and CSF leakage, etc.Results Patients had a significant relieve in symptoms and function in both of the two groups( p﹤0.01). There was a significant difference between the two groups at 4weeks, 12 weeks and 24 weeks postoperative in VAS and NDI( p﹤0.05), which showed an inferiority of the group CNRB. NDI postoperative had a significant difference in group DLRS( p﹤0.01), while NDI of group CNRB and VAS of two groups didn’t( p﹥0.05). The SF-36 scale and the PSS showed an inferiority of the group CNRB 24 weeks after procedure( p﹤0.05). Finally, there was only one complication(radiculitis) in the group DLRS(3.57%). The length of hospital stay and the total cost of hospitalization in group DLRS was significant lower than group CNRB( p﹤0.001).Conclusion The result suggests that DLRS, as a new minimally invasive procedure which has a principal of disc repair and decompression, has a better effect, less complications compared with the SCNRB therapy. It’s quite clear that DLRS would play an important role in the treatment for cervical disc herniation in the future.