Patient-Reported Outcome Measures Following Coblation Nucleoplasty for Cervical Discogenic Dizziness

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Jul 14

PMID 37445446

Authors

Yongchao Li

Bing Wu

Mao Li

Xiaodong Pang

Liang Yang

Chen Dai

Baogan Peng

Affiliations

Soon will be listed here.

Abstract

Background: There is little research in the literature comparing the efficacy of coblation nucleoplasty with conservative treatment in the treatment of cervical discogenic dizziness and reporting the achieved rate of minimal clinically important differences (MCID) and patient acceptable symptom state (PASS) after surgery. This retrospective study aims to explore the patient-reported outcome measures (PROM) following coblation nucleoplasty for cervical discogenic dizziness and to compare the therapeutic effect of coblation nucleoplasty with prolonged conservative treatment.

Methods: Sixty-one patients with cervical discogenic dizziness and a positive intradiscal diagnostic test eligible for single-level cervical coblation nucleoplasty were included in the study. Among these 61 patients, 40 patients underwent cervical coblation nucleoplasty, while the remaining 21 patients refused surgery and received continued conservative treatment. The primary PROMs were the intensity and frequency of dizziness and secondary PROMs were related to the neck disability index (NDI) and visual analog scale (VAS) for neck pain (VAS-neck) during a 12-month follow-up period. Moreover, the achieved rate of MCID and PASS in both groups was assessed 12 months after surgery.

Results: Dizziness intensity, dizziness frequency, VAS-neck score, and NDI score were significantly improved from the baseline at all follow-up time points in both treatment groups, except for showing no significant improvement in dizziness frequency in the conservative treatment group at 6 and 12 months after surgery. However, at each follow-up time point, the above indexes were lower in the surgery group than in the conservative treatment group. In addition, the achieved rates for PASS and MCID in all indexes in the surgery group were significantly higher than those in the conservative treatment group at 12 months after surgery.

Conclusions: Cervical coblation nucleoplasty significantly improved the intensity and frequency of dizziness, neck pain, and NDI in patients with cervical discogenic dizziness, and the results were superior to those from prolonged conservative treatment. Meanwhile, cervical coblation nucleoplasty is a good choice for patients with chronic neck pain and refractory cervical discogenic dizziness who have not demonstrated the indications for open surgery and have not responded well to conservative treatment.

References

Mannion A, Loibl M, Bago J, Vila-Casademunt A, Richner-Wunderlin S, Fekete T . What level of symptoms are patients with adult spinal deformity prepared to live with? A cross-sectional analysis of the 12-month follow-up data from 1043 patients. Eur Spine J. 2020; 29(6):1340-1352. DOI: 10.1007/s00586-020-06365-z. View

Liu T, Liu Y, Peng B . Cervical intervertebral disc degeneration and dizziness. World J Clin Cases. 2021; 9(9):2146-2152. PMC: 8017505. DOI: 10.12998/wjcc.v9.i9.2146. View

Li S, Chen R, Chen Y, Mo G, Zhang L, Xie P . Therapeutic Effects and Safety of Percutaneous Disc Decompression with Coblation Nucleoplasty in Cervical Vertigo: A Retrospective Outcome Study with 74 Consecutive Patients and Minimum 1-Year Follow-Up. Pain Physician. 2019; 22(3):E205-E214. View

Li Y, Yang L, Dai C, Peng B . Proprioceptive Cervicogenic Dizziness: A Narrative Review of Pathogenesis, Diagnosis, and Treatment. J Clin Med. 2022; 11(21). PMC: 9655761. DOI: 10.3390/jcm11216293. View

Peng B, Yang L, Yang C, Pang X, Chen X, Wu Y . The effectiveness of anterior cervical decompression and fusion for the relief of dizziness in patients with cervical spondylosis: a multicentre prospective cohort study. Bone Joint J. 2018; 100-B(1):81-87. DOI: 10.1302/0301-620X.100B1.BJJ-2017-0650.R2. View

Yang L, Yang C, Pang X, Li D, Yang H, Zhang X . Mechanoreceptors in Diseased Cervical Intervertebral Disc and Vertigo. Spine (Phila Pa 1976). 2016; 42(8):540-546. DOI: 10.1097/BRS.0000000000001801. View

Karlberg M, Persson L, Magnusson M . Impaired postural control in patients with cervico-brachial pain. Acta Otolaryngol Suppl. 1995; 520 Pt 2:440-2. DOI: 10.3109/00016489509125293. View

Reddy R, Tedla J, Dixit S, Abohashrh M . Cervical proprioception and its relationship with neck pain intensity in subjects with cervical spondylosis. BMC Musculoskelet Disord. 2019; 20(1):447. PMC: 6794723. DOI: 10.1186/s12891-019-2846-z. View

Yi Y, Xu H, Zhang S, Hu T, Wang S, Wu D . Does the C3/4 disc play a role in cervical spondylosis with dizziness? A retrospective study. Int Orthop. 2020; 44(6):1159-1168. DOI: 10.1007/s00264-020-04531-y. View

10.

Goh G, Yue W, Guo C, Tan S, Chen J . Defining threshold values on the neck disability index corresponding to a patient acceptable symptom state in patients undergoing elective surgery for degenerative disorders of the cervical spine. Spine J. 2020; 20(8):1316-1326. DOI: 10.1016/j.spinee.2020.05.004. View

11.

Yang L, Chen J, Yang C, Pang X, Li D, Wu B . Cervical Intervertebral Disc Degeneration Contributes to Dizziness: A Clinical and Immunohistochemical Study. World Neurosurg. 2018; 119:e686-e693. DOI: 10.1016/j.wneu.2018.07.243. View

12.

Malmstrom E, Eva-Maj M, Westergren H, Hans W, Fransson P, Per-Anders F . Experimentally induced deep cervical muscle pain distorts head on trunk orientation. Eur J Appl Physiol. 2013; 113(10):2487-99. DOI: 10.1007/s00421-013-2683-y. View

13.

Colledge N, Lewis S, Sellar R, Wilson J . Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ. 1996; 313(7060):788-92. PMC: 2352174. DOI: 10.1136/bmj.313.7060.788. View

14.

Adindu E, Singh D, Geck M, Stokes J, Truumees E . Minimal Clinically Important Difference and Patient-Acceptable Symptom State in Orthopaedic Spine Surgery: A Review. JBJS Rev. 2023; 11(4). DOI: 10.2106/JBJS.RVW.22.00200. View

15.

Peng B . Cervical Vertigo: Historical Reviews and Advances. World Neurosurg. 2017; 109:347-350. DOI: 10.1016/j.wneu.2017.10.063. View

16.

He L, Lai R, Leff J, Yuan R, Yue J, Ni J . Cervicogenic dizziness alleviation after coblation discoplasty: a retrospective study. Ann Med. 2021; 53(1):639-646. PMC: 8057077. DOI: 10.1080/07853890.2021.1910336. View

17.

Li C, Qi Y, Liu G, Yin X, Jin Y, Jiang Z . Long-Term Clinical Outcomes of Percutaneous Cervical Nucleoplasty for Cervical Degenerative Diseases with Neck Pain and Cervical Vertigo. World Neurosurg. 2019; 133:e205-e210. DOI: 10.1016/j.wneu.2019.08.210. View

18.

Li J, Jiang D, Wang X, Yuan W, Liang L, Wang Z . Mid-term Outcomes of Anterior Cervical Fusion for Cervical Spondylosis With Sympathetic Symptoms. Clin Spine Surg. 2012; 29(6):255-60. DOI: 10.1097/BSD.0b013e31827b4cec. View

19.

Yacovino D, Hain T . Clinical characteristics of cervicogenic-related dizziness and vertigo. Semin Neurol. 2013; 33(3):244-55. DOI: 10.1055/s-0033-1354592. View

20.

Carreon L, Glassman S, Campbell M, Anderson P . Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J. 2010; 10(6):469-74. DOI: 10.1016/j.spinee.2010.02.007. View