MRI导引椎间盘切割联合臭氧治疗颈椎间盘突出症

MRI-guided percutaneous cervical discectomy and discolysis with oxygen-ozone mixture for treatment of cervical disc herniation： an initial experience

目的探讨应用0．23T开放性MR导引，椎间盘切割联合臭氧治疗颈椎间盘突出症的疗效。方法经MRI证实为颈椎间盘突出症的患者7例8个椎间盘，侧突型5个、旁中央型2个、中央型1个。在0．23T开放式MR及iPath200光学追踪系统的导引下，自健侧颈前外侧进针，避开颈动脉鞘、甲状腺、食管及椎动脉等结构，穿刺至椎间盘中心，并继续进针至椎间盘突出部分。应用椎间盘切除器切除突出部分后注射60μg／mlO2～O3混合气体2ml，然后退针至椎间盘中心髓核处，切除部分髓核组织并注入60μg／mlO2～O3混合气体2ml。术后随访：4例经电话随访、3例经门诊随访，随访时间6个月，观察患者临床症状改善情况。疗效评价采用Williams术后评价标准。结果疗效评估优5例、良1例、可1例。本组除1例术中感觉颈部一过性疼痛外，其他患者无并发症出现。结论开放性MR导引经皮颈椎间盘切割联合臭氧消融治疗颈椎间盘突出症安全、有效、创伤小。

Objective To explore the value of MR imaging-guided percutaneous cervical discectomy and discolysis with oxygen-ozone mixture for treatment of cervical disc herniation. Methods Eight herniated cervical discs in 7 patients were diagnosed by MRI, including 5 discs of lateral protruding type, 2 discs of paramedian protruding type and one disc of central protruding type. All patients underwent MR imagingguided percutaneous cervical discectomy and discolysis with oxygen-ozone mixture. The procedures were guided by a set of 0. 23 T open MR system mounted with iPath 200 optical tracking system. The herniated portion of the disc was punctured with a 14 G MR-compatible needle in the healthy side via anterolateral oblique route. The interventional steps were as follows： firstly, cut herniated part with percutaneoas diseeetomy probe and inject 2ml oxygen-ozone mixture of 60μg/ml; secondly, retreat the needle to the disc center, resect nucleus pulposus, and inject 2 ml oxygen-ozone mixture of 60μg/ml. All patients were followed up for 6 months, with 4 patients by telephone and 3 patients in outpatient clinic. The effect of treatment was evaluated according to Williams postoperative assessment standard. Results All procedures were performed successfully. The clinical outcome was evaluated as excellent in 5 cases, good in 1 case and fair in 1 ease. The total ratio of excellent and good was 85.7%. No serious complication occurred expect 1 case with intraoperative paroxysmal pain. Conclusion MR imaging-guided pereutaneous cervical disceetomy and discolysis with oxygen-ozone mixture was a safe, effective and minimally invasive method for the treatment of cervical disc herniation.