CT-guided Target Injection Of Collagenase In Treatment Of Huge Cervical Disc Herniation Clinical Study

Objective: Investigate clinical efficacy and safety target injection of high-concentration low-volume collagenase solution in treatment of huge cervical disc herniation, through cervical disc puncture via anterolateral cervical approach, and by adjusting the needle position according to distribution of the contrast agent.Provide new therapeutic approaches for the clinical treatment of huge cervical disc herniation.Method: As shown by CT scan, the patients with huge cervical disc herniation are included as research object, in whom huge cervical disc herniation has typical clinical manifestations of cervical disc herniation, and is identified by its sagittal diameter of spinal canal being larger than that of the same segments by one half; those with contraindications to collagenase chemonucleolysis of cervical disc were excluded. According to the patients’ wishes they are assigned into two groups, i.e. Collagenase + Neuro-blocking Therapy Group(Group A), and Neuro-blocking Therapy Group(Group B) In Group A, consisted of 30 patients, the needle is advanced into the cervical disc, through CT-guided puncture via the anterolateralcervical approach, and 0.1 m L of contrast is injected; the needle is adjusted to reach a satisfactory position according to the distribution of contrast agent, and 0.2-0.3 m L of collagenase solution(containing 300 U of collagenase) is injected intermittently in several portions. On Day 2 after the procedure, the cervical epidural neuro-blocking therapyisused; using C7-T1 as the puncture point, cervical epidural space puncture intubation is carried out, and 2% Lidocaine 3 m L, Dexamethasone 10 mg, Vitamin B1 100 mg, and Vitamin B12 1000 μg, and Saline 12 m L in total is injected via the epidural catheter. The therapy is carried out once per week, for 4 times in total. In Group B,consisted of 27 patients, the cervical epidural neuro-block therapy is used alone. The visual ananlogue scale in the patients of the two groups are recorded in 3 day, 7 days, 1 month, and half a year after treatment. The comprehensive efficacies in the patients of the two groups are assessed in 1 week, 1 month, and half a year by the modified Macnab method. Calculated the reduction rate of projections by CT rescan are followed up in half a year after the procedure. The patients in the two groups are observed for occurrences of adverse during and after treatment.Results: There were no significant differences(P >0.05) of ages, sexes, and disease courses in the patients between the two groups. 1. Visual ananlogue scale comparison: Group A: Compared with the VAS scores prior to the procedure, those in 3 days after the procedure were decreased significantly(P <0.05); compared with the VAS scores prior to the procedure, those in 1 week, 1 month, and 6 months after the procedure were decreased significantly(P <0.01). Group B: Compared with the VAS scores prior to the procedure, those in 3 days, 1 week, and 1 month after treatment are decreased significantly(P <0.01); compared with the VAS scores prior to the procedure, those in half a year after treatment were decreased significantly(P <0.05). Inter-groupcomparison: There were no significant differences(P >0.05) of the VAS scores in 3 days and 1 week after the procedure between the two groups, and the pain relief degrees were consistent between the two groups; there were significant differences(P <0.05) of the VAS scores in 1 month after the procedure between the two groups, and the pain relief degrees in Group A were more significant than those in Group B; there were significant differences(P <0.01) of the VAS scores in half a year between the groups, and the pain relief degrees in Group A were much more significant than those in Group B. 2. Comprehensive Efficacies Assessed by the Modified Macnab Method after the Procedure: There were no statistically significant differences(P >0.05) of effective rates in 1 week and 1 month after procedure between Groups A and B;there were significant differences(P <0.01) of effective rates in half a month between Groups A and B(those in Group A were better than those in Group B). There were significant differences(P<0.01) of good rates in 1 week between Groups A and B(those in Group B were better than those in Group B); there were no significant differences(P >0.05) of good rates in 1 month between Groups A and B; there were significant differences(P <0.01) of good rates in half a month between Groups A and B(those in Group A were better than those in Group B). 3. Imaging Changes after the Procedure in Group A: By cervical CT rescan in half a year after the procedure in 18 patients, the good rate of protrusion reduction was 94.4%. 4. Adverse Reactions: In the two groups,there were no cases with erroneous access to subarachnoid space or with spinal cordinjury, and by long-term follow-up, there were no deaths or cases with severe complications.Conclusion: 1. The methodology is feasible for target injection of high-concentration low-volume collagenase solution in treatment of huge cervical disc herniation, through CT-guided cervical disc puncture via anterolateral cervical approach, and by adjusting the needle to the optimal position according to distribution of the contrast agent. 2. The results from VAS scores, and from assessment of comprehensive efficacies by the modified Macnab Method showed: The mid- and long-term efficacies by injection of collagenase into cervical disc plus neuro-blocking therapy in treatment of huge cervical disc herniation are better than those by neuro-blocking therapy alone.