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Cervical intervertebral disc herniation treatment via radiofrequency combined with low-dose collagenase injection into the disc interior using an anterior cervical approach

View Article: PubMed Central - PubMed

ABSTRACT

This study aimed to determine the therapeutic effect of radiofrequency combined with low-dose collagenase injected into the disc interior via an anterior cervical approach for cervical intervertebral disc herniation.

Forty-three patients (26–62-year old; male/female ratio: 31/12) with cervical intervertebral disc herniation received radiofrequency combined with 60 to 100 U of collagenase, injected via an anterior cervical approach. The degree of nerve function was assessed using the current Japanese Orthopaedic Association (JOA) scoring system at 3 and 12 months postoperation. A visual analogue scale (VAS) was used to evaluate the degree of pain preoperation and 7 days postoperation. The preoperative and 3 month postoperative protrusion areas were measured and compared via magnetic resonance imaging (MRI) and picture archiving and communication systems (PACS).

Compared with the preoperative pain scores, the 7-day postoperative pain was significantly reduced (P <0.01). The excellent and good rates of nerve function amelioration were 93.0% and 90.7% at 3 and 12 months postoperation, respectively, which was not significantly different. Twenty-seven cases exhibited a significantly reduced protrusion area (P <0.01) at 3 months postoperation. No serious side effects were noted.

To our knowledge, this is the first study to demonstrate that the use of radiofrequency combined with low-dose collagenase injection into the disc interior via an anterior cervical approach is effective and safe for the treatment of cervical intervertebral disc herniation.

No MeSH data available.


Related in: MedlinePlus

Puncture to the target site via an anterior cervical approach.
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Figure 1: Puncture to the target site via an anterior cervical approach.

Mentions: After sterilization and disinfection of the operation site, 1% lidocaine (Shanghai Zhaohui Pharmaceutical Co, LTD, Shanghai, China) was administered for local anesthesia. A radiofrequency needle (model-22G, 10-cm long, work terminal 5 mm, Elekta (Shanghai) Electa Medical Machinery Co, LTD, Stockholm, Sweden) was directed toward the basement of the protrusion using an anterior cervical approach from the contralateral side under fluoroscopic guidance (Fig. 1). When the needle was radiographically determined to be located in the basement of the protrusion, 0.2 to 0.4 mL of contrast media (iohexol, GE (Shanghai) Pharmaceutical Industry, Shanghai, China) was injected to visualize the protrusion. Then, 60 to 100 IU/0.2 to 0.4 mL of collagenase (Liaoning Weibang Biological Pharmaceutical Co, LTD, Liaoning, China) were injected. Following complete injection, electrical impedance was measured using an electrode in the cervical disc. For reference, the electrical impedance of the nucleus pulposus in the cervical intervertebral disc is 150 to 300 Ω. A sensory evoked test (100 Hz, 0.5–1.0 mA) and a motor evoked trial (2 Hz, 0.5–2.0 mA) were subsequently conducted. If these processes did not induce pain or muscle contraction, it indicated the electrode was distal to the nerve root. The initial working parameter was set to 70°C for 60 seconds to conduct single consecutive radiofrequency thermocoagulation, followed by a stepwise increase to 80°C for 30 seconds and 85°C for 60 seconds. The cervicobrachial pain and warm sensation may be duplicated, but electric shock-like numbness or pain should be avoided, which reconfirms that the electrode is localized at the target and distal to the nerve root. The parameters were subsequently set to 90°C for 90 seconds for 2 cycles. The patient was then assessed to determine neurological function and pain scores during the procedure.


Cervical intervertebral disc herniation treatment via radiofrequency combined with low-dose collagenase injection into the disc interior using an anterior cervical approach
Puncture to the target site via an anterior cervical approach.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998330&req=5

Figure 1: Puncture to the target site via an anterior cervical approach.
Mentions: After sterilization and disinfection of the operation site, 1% lidocaine (Shanghai Zhaohui Pharmaceutical Co, LTD, Shanghai, China) was administered for local anesthesia. A radiofrequency needle (model-22G, 10-cm long, work terminal 5 mm, Elekta (Shanghai) Electa Medical Machinery Co, LTD, Stockholm, Sweden) was directed toward the basement of the protrusion using an anterior cervical approach from the contralateral side under fluoroscopic guidance (Fig. 1). When the needle was radiographically determined to be located in the basement of the protrusion, 0.2 to 0.4 mL of contrast media (iohexol, GE (Shanghai) Pharmaceutical Industry, Shanghai, China) was injected to visualize the protrusion. Then, 60 to 100 IU/0.2 to 0.4 mL of collagenase (Liaoning Weibang Biological Pharmaceutical Co, LTD, Liaoning, China) were injected. Following complete injection, electrical impedance was measured using an electrode in the cervical disc. For reference, the electrical impedance of the nucleus pulposus in the cervical intervertebral disc is 150 to 300 Ω. A sensory evoked test (100 Hz, 0.5–1.0 mA) and a motor evoked trial (2 Hz, 0.5–2.0 mA) were subsequently conducted. If these processes did not induce pain or muscle contraction, it indicated the electrode was distal to the nerve root. The initial working parameter was set to 70°C for 60 seconds to conduct single consecutive radiofrequency thermocoagulation, followed by a stepwise increase to 80°C for 30 seconds and 85°C for 60 seconds. The cervicobrachial pain and warm sensation may be duplicated, but electric shock-like numbness or pain should be avoided, which reconfirms that the electrode is localized at the target and distal to the nerve root. The parameters were subsequently set to 90°C for 90 seconds for 2 cycles. The patient was then assessed to determine neurological function and pain scores during the procedure.

View Article: PubMed Central - PubMed

ABSTRACT

This study aimed to determine the therapeutic effect of radiofrequency combined with low-dose collagenase injected into the disc interior via an anterior cervical approach for cervical intervertebral disc herniation.

Forty-three patients (26–62-year old; male/female ratio: 31/12) with cervical intervertebral disc herniation received radiofrequency combined with 60 to 100 U of collagenase, injected via an anterior cervical approach. The degree of nerve function was assessed using the current Japanese Orthopaedic Association (JOA) scoring system at 3 and 12 months postoperation. A visual analogue scale (VAS) was used to evaluate the degree of pain preoperation and 7 days postoperation. The preoperative and 3 month postoperative protrusion areas were measured and compared via magnetic resonance imaging (MRI) and picture archiving and communication systems (PACS).

Compared with the preoperative pain scores, the 7-day postoperative pain was significantly reduced (P <0.01). The excellent and good rates of nerve function amelioration were 93.0% and 90.7% at 3 and 12 months postoperation, respectively, which was not significantly different. Twenty-seven cases exhibited a significantly reduced protrusion area (P <0.01) at 3 months postoperation. No serious side effects were noted.

To our knowledge, this is the first study to demonstrate that the use of radiofrequency combined with low-dose collagenase injection into the disc interior via an anterior cervical approach is effective and safe for the treatment of cervical intervertebral disc herniation.

No MeSH data available.


Related in: MedlinePlus