Efficiency Of Epidural Collagenase Discolysis Combined With Percutaneous Coblation Nucleoplasty For The Treatment Of Cervical Spondylosis

BackgroundCervical spondylosis(CS)refers to the compression or stimulation of adjacent nerve roots,sympathetic nerves,spinal cord,blood vessels and esophagus due to cervical osseous hyperplasia,ligament and intervertebral disc degeneration,accompanied by a series of corresponding symptoms and signs.The epidemiological studies reported that the prevalence of cervical spondylosis was 13.76%,which was higher than the prevalence of diabetes(9.7%)and seriously affects people's physical and mental health and quality of daily life.Conservative treatment is often poor,but surgical procedures have the disadvantages of trauma,long hospital stay,long recovery time,and high cost.Only the epidural collagenase discolysis of CS is effective and inexpensive and it has been widely used in clinical practice.However,there are often some problems such as congestion and edema in the spinal canal tissue after collagenase injection,and swelling of the intervertebral disc tissue at the site of action,which temporarily aggravate the pain.In the past 10 years,studies have reported that percutaneous coblation nucleoplasty(PCN)is a safe,effective,recovery rapidly,and can be performed in the clinic.Since both methods have their own advantages,we propose that PCN combined with epidural collagenase discolysis for the treatment of CS has theoretically double efficacies and complementary advantages.In our hospital from January 2016 to June 2018,both PCN combined with epidural collagenase chemonucleolysis and only chemonucleolysis for the treatment of CS have good effects.The report is as follows:ObjectiveTo evaluate the efficacy of PCN combined with epidural collagenase discolysis in the treatment of CS and to explore the influencing factors of the therapeutic effect.MethodsCS patients who received PCN combined with epidural collagenase discolysis in Shandong Provincial Hospital from January 2016 to June 2018 were enrolled in our study group B.20 patients treated with epidural collagenase discolysis were randomly selected as group A in the same period of time.The general information of patients was recorded by consulting medical records,telephone follow-up,outpatient review and so on,and the degree of pain before and after treatment was evaluated by Numerical rating scale.NRS score and Macnab efficacy of the two groups were observed at 7 days,1 month,3 months and 6 months after treatment by t test,repeated measurement analysis of variance and chi-square test.Logistic regression analysis was used to analyze the relationship between sex,age,height,weight,BMI,course of disease,lesion segments,disease classifications,smoking history,diabetes,hypertension and 6-month curative effect.ResultsThere were no significant differences between the two groups among sex,age,height,weight,BMI,course of disease,lesion segments,disease classifications,preoperative NRS scores,smoking history,diabetes and hypertension(P>0.05).The NRS scores of the two groups after treatment were lower than before treatment(P<0.05).There were no significant differences in NRS scores and Macnab between group A and group B at 7 days,1 month,3 months,and 6 months after treatment(P>0.05)Conclusion1.PCN combined with epidural collagenase discolysis and simple discolysis for the treatment of CS can be used as a reference for clinical.2.There were no significant differences in the effects of PCN combined with epidural collagenase discolysis and simple discolysis for the treatment of CS.3.Sex,age,height,weight,BMI,course of disease(<1 year,? 1 year),lesion segments(single and multiple segments),disease classifications(neural root type,spinal type,mixed type),smoking history,diabetes and hypertension were not the influencing factors of 6-month curative effect for the treatment of CS.