1. 2019;22;E205-E214Therapeutic 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
   Observational Study
   Jianwen Dong, PhD, Bin Liu, PhD, Qiyou Wang, PhD, Peigen Xie, PhD, Liangming Zhang, PhD, Guoshu Mo, MD, Yuyong Chen, PhD, Ruiqiang Chen, PhD, Shangfu Li, PhD, and Limin Rong, PhD.

BACKGROUND: Surgical treatment of cervical vertigo has been rarely reported. This is the first retrospective study to evaluate the clinical outcomes of percutaneous disc decompression with coblation nucleoplasty (PDCN) for treatment of cervical vertigo.

OBJECTIVES: To assess the clinical outcomes of patients with cervical vertigo who failed to improve with conservative care and who were subsequently treated with PDCN.

STUDY DESIGN: This study used a retrospective design.

SETTING: The research was conducted within an interventional vertigo management and spine practice.

METHODS: Seventy-four consecutive patients with cervical vertigo underwent PDCN and were followed for at least one year. Outcome measures included the dizziness intensity Visual Analog Scale (VAS), dizziness frequency, the Dizziness Handicap Inventory (DHI), and neck pain intensity. Clinical efficacy was assessed by rating scale and the modified MacNab evaluation criteria. Surgical complications during the operation and follow-up were also recorded.

RESULTS: The vertigo VAS score, frequency of dizziness, DHI, and neck pain intensity were all decreased significantly from evaluation before surgery to one week after surgery and to the last follow-up, giving a mean effective rate of 94.6% one week after surgery and 90.6% at the last follow-up. Good to excellent results were attained in 85.1% of these patients one week after PDCN and in 75.7% of the sufferers at the last follow-up (P < 0.001). There were 5 patients with transient adverse effects (6.25%) reported within the first month after surgery; they all recovered after conservative treatment. No neurological complications were found and no patient went on to spinal fusion surgery thereafter.

LIMITATIONS: The rate of follow-up was 70% and a placebo effect cannot be excluded. There is no gold standard for the diagnosis and treatment of cervical vertigo so far.

CONCLUSION: The clinical outcomes of PDCN for cervical vertigo were satisfactory in both the early and late postoperative period. PDCN is an effective, low-complication, minimally invasive procedure used to treat cervical vertigo. Further prospective randomized controlled trials are essential to verify this conclusion.

KEY WORDS: Cervical vertigo, percutaneous disc decompression, coblation nucleoplasty, long-term outcome, dizziness intensity, dizziness frequency, dizziness handicap inventory, clinical efficacy, surgical complication, retrospective study