利用經皮頸椎間盤髓核成形術治療頸肩痛之一年期追蹤報告

Treatment of Cervicobrachialgia Utilizing Percutaneous Cervical Disc Nucleoplasty : One Year Follow-Up

目標：疼受肩頸痛所困擾之病患目前接受之治療方法，只有保守治療及單段落椎骨結合術或強調關節活動性之人工椎間盤。我們要評估一種創新經皮椎間盤減壓術＂經皮頸椎間盤髓核成形術＂臨床表現與效果。方法：自2008年10月至2009年10月，共29位經磁振造影證明患上頸椎椎間盤突出之病患。平均接受保守治療3個月後，再接受於頸椎椎間盤病灶進行Perc-DCR® Spine Wand（Arthrocare®）之經皮髓核成形術。在同一錄取標準下，另有29病例登錄為隨機對照組，並只有接受保守治療。隨著1年之跟進，我們發現評估疼痛之視覺類比量表有平均減少。疼痛良表示於接受治療後之24小時，1週，3，6及12月評估。結果：共有18位女性及11位男性病患，其年齡分佈由23至49歲，在接受手術治療前之平均疼痛視覺類比量為8.8。於一年後之追蹤為2.3。於對照組，其年齡分佈由26至56歲，在接受保守治療前之平均疼痛視覺類比量為8.4。頸椎椎間盤突出病灶分佈位置於保守治療及手術治療兩組為：頸椎第4／5節（8比7人），頸椎第5／6節（19比17人）及頸椎第6／7節（2比6人）。共進行29次經皮頸椎間盤髓核成形術（其中3次是共同治療上下相連2節）。使用Perc-DCR Spine Wand進行手術，有8例是治療於頸椎第4／5節（佔28%），19例於第5／6節（佔65%），2例於第6／7節（佔7%）。所有病患能於手術後即時下床活動，沒有因為此手術引起任何併發症。結論：經皮頸椎間盤髓核成形術是一種快速及安全的方法來治療肩痛。另外，頸椎間盤髓核成形術之理想治療效果時期縮減為1至3個月。

Objective Patients suffering from cervicobrachialgia had only the therapeutical solution between conservative treatment and monosegmental spondylodesis or disc prosthesis of the mentioned motion segment. We want to evaluate the effect of a clinically demonstrated innovation 'percutaneous cervical disc nucleoplasty' in percutaneous disc decompression. Methods From October 2008 to October 2009, 29 patients with magnetic resonance imaging (MRI) proven contained herniated cervical disc were treated by nucleoplasty with the Perc- DC® Spine Wand (Arthrocare®) on the pathological disc after conservative treatment about on average 3 months. A control group of 29 patients was enrolled within the same criteria with only conservative treatment. With a follow-up time of 1-years we evaluated an average pain reduction by the visual pain score (VAS). The VAS was checked 24 h, 1 week, 3, 6, 12 months after treatment. Results There were 18 female and 11 male persons with a mean age of 23 49 years. The mean VAS was 8.8 just before surgical treatment and 2.3 after 1 year follow-up. The mean age of the persons was 26-56 years. The VAS was 8.4 on average just before starting conservative treatment. The distribution of the prolapse to the motion segment of the cervical spine was conservative/surgical group: C4/5 (8 respectively 7 patients), C5/6 (19 respectively 17 patients) and C6/7 (2 respectively 6 patients.) The total number of 29 nucleoplasty were performed (three on two adjacent levels). The C4/5 disc level was treated in eight cases (28%), C5/6 in 19 cases (65%) and C6/7 in two cases (7%) with the Perc-DC® Spine Wand. All patients were immediately mobilized. No complications with this method were seen. Conclusion Percutaneous cervical disc nucleoplasty is a fast and secure treatment for cervicobrachialgia. Furthermore, a diminution of pain after the cervical nucleoplasty which has the optimal results without taking medication after 1 to 3 months was found .