Servikal Lazer Diskektomide Başlangıç Görsel Analog Skala Skorunun Sonuçlara Etkisi

Amaç Perkütan lazer disk dekompresyonunun (PLDD) gerçekten etkili olup olmadığı konusunda görüş ayrılığı vardır. Bunun sebebi, ek hasta kabul ve red kriterlerine ihtiyaç duyulması nedeniyle yanlış hasta seçimine bağlanabilir. Bu çalışma, kabul anındaki görsel analog skala (VAS) skorunun servikal PLDD sonuçları üzerinde bir etkisinin olup olmadığını ve bunun bir hasta seçim kriteri olup olmadığını araştırmayı amaçlamaktadır. Gereç ve Yöntemler: Servikal PLDD yapılan hastalar, kabul anındaki VAS skorlarına göre Grup-I (VAS: 3-5), Grup-IIa (VAS: 6-7) ve Grup-IIb (VAS: 8-9) olarak 3 gruba ayrıldı. Veriler geriye dönük olarak analiz edildi ve 12 aylık takip süresince VAS skorlarıyla karşılaştırıldı. İlk VAS skorları ile işlemin başarısı arasındaki ilişki araştırıldı. Hasta memnuniyeti ise Odom kriterlerine göre değerlendirildi. Bulgular: Tüm hastalar birlikte değerlendirildiğinde, hastaların % 79.16'sı işlemden memnun olduğunu belirtti. Bununla birlikte, memnuniyet oranı Grup-I'de % 96.15, Grup-IIa'da % 76.47 ve Grup-IIb'de % 0.0 idi. İşlemden memnun olan hastaların ortalama başlangıç VAS skorları 5.08 iken memnun olmayanların 7.30’du. Etkilenen disk sayısı ve hasta yaşının sonuçlar üzerinde etkili olmadığı belirlendi. Sonuç: Kabul anındaki VAS skorları, hasta sonuçlarıyla doğrudan ilişkilidir. Başlangıç VAS skoru 5'ten daha yüksek olan hastalar PLDD için reddedilmelidir.

Anahtar Kelimeler:

Görsel analog skala, Servikal disk herniasyonu, Perkutan lazer disk dekompresyonu, Hasta seçimi

The Effect of Initial Visual Analog Scale Score on Results in Cervical Laser Discectomy

Objective There is disagreement as to whether percutaneous laser disc decompression (PLDD) is effective. This may be attributed to incorrect patient selection because of the need of additional criteria. This study is investigating whether initial visual analog scale (VAS) score has an effect on outcomes of cervical PLDD and whether it could be a patient selection criterion. Material and Methods: Cervical PLDD patients were divided into 3 groups according to initial VAS scores as Group-I (VAS:3-5), Group-IIa (VAS:6-7) and Group-IIb (VAS:8-9). Datas analyzed retrospectively and compared with the VAS scores during 12-month follow-up. Relationship between initial VAS scores and success of procedure was investigated. Patient satisfaction was also evaluated according to Odom criteria. Results: In sum, 79.16 % of the patients were satisfied from the procedure. However, the satisfaction rate was 96.15% in Group-I, 76.47 % in Group-IIa, and 0.0 % in Group-IIb. The mean initial VAS scores of patients who were satisfied with the procedure was 5.08 but 7.30 of dissatisfied ones. Number of affected discs and patient age have no effect on the results. Conclusion: Initial VAS scores are directly correlated with patient outcomes. Patients with higher than initial VAS scores of 5, must be rejected for the procedure.

Keywords:

Visual analog scale, Cervical disc herniation, Percutaneous laser disc decompression, Patient selection,

PDF

___

1- Freeman BJC. IDET: a critical appraisal of the evidence. Eur Spine J. 2006;15 (Suppl. 3): S448–S457.
2- Cohen SP, Larkin T, Abdi S. Risk factors for failure and complications of intradiscal electrothermal therapy: a pilot study. Spine (Phila Pa 1976). 2003;28:1142-1147.
3- Pauza KJ, Howell S, Dreyfuss P, JH Peloza, K Dawson. A randomised, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine J. 2004;4:27-35.
4- Saal JA, Saal JS. Intradiscal electrothermal treatment for chronic discogenic low back pain. A prospective outcome study with a minimum 1-year follow-up. Spine (Phila Pa 1976). 2000;25:2622-2627.
5- Saal, JS, Saal JA. Management of chronic discogenic low back pain with a thermal intradiscal catheter: a preliminary report. Spine (Phila Pa 1976). 2000;25:382-388.
6- Ceylan A, Aşık İ. Percutaneous navigable intradiscal decompression in treatment of lumbar disc herniation: a single-center experience. Turk J Med Sci. 2019;49: 519-524.
7- Karasek M, Bogduk N: Twelve-month follow-up of a controlled trial of intradiscal thermal anuloplasty for back pain due to internal disruption. Spine (Phila Pa 1976). 2000;25:2601-2607.
8- Saal JA, Saal JS. Intradiscal electrothermal treatment for chronic discogenic low back pain. A prospective outcome study with a minimum 2-year follow-up. Spine (Phila Pa 1976). 2002;27:966-973.
9- Kim SH, Lee SH, Kim NH, Kim MH, Park HJ, Jung YJ, Yoo HJ, Meng WJ, Kim V. Clinical Efficacy of Selective Focal Ablation by Navigable Percutaneous Disc Decompression Device in Patients With Cervical Herniated Nucleus Pulposus. Ann Rehabil Med. 2017;41(1):80-89.
10- Chen YC, Lee SH, Saenz Y, Lehman NL. Histologic findings of disc, end plate and neural elements after coblation of nucleus pulposus: an experimental nu¬cleoplasty study. Spine J. 2003;3:466-470.
11- Hijikata S. Percutaneous nucleotomy: a new concept technique and 12 years’ experience. Clin Orthop Relat Res. 1098;238:9-23.
12- Singh V, Piryani C, Liao K, Nieschulz S. Percutaneous disc decompression using coblation (nucleoplasty) in the treatment of chronic discogenic pain. Pain Physician. 2002;5: 250-259.
13- Binch ALA, Cole AA, Breakwell LM, Michael ALR, Chiverton N, Creemers LB, Cross AK, Le Maitre CL. Nerves are more abundant than blood vessels in the degenerate human intervertebral disc. Arthritis Res Ther. 2015;17:370.
14- Wu B, Yang L, Peng B. Ingrowth of Nociceptive Receptors into Diseased Cervical Intervertebral Disc Is Associated with Discogenic Neck Pain. Pain Med. 2019;20(6):1072-1077.
15- Lee MS, Cooper G, Lutz GE, Lutz C, Hong HM. Intradiscal electrothermal therapy (IDET) for treatment of chronic lumbar discogenic pain: a minimum 2-year clinical outcome study. Pain Physician. 2003;6:443-448.
16- Davis TT, Delamarter RB, Sra P, Goldstein TB. The IDET procedure for chronic discogenic low back pain. Spine (Phila Pa 1976). 2004;29:752-756.
17- Freedman BA, Cohen SP, Kuklo TR, Lehman RA, Larkin P, Giuliani JR. Intradiscal electrothermal therapy (IDET) for chronic low back pain in active-duty soldiers: 2-year follow-up. Spine J. 2003;3:502-509.
18- Webster BS, Verma S, Pransky GS Outcomes of workers’ compensation claimants with low back pain undergoing intradiscal electrothermal therapy. Spine (Phila Pa 1976). 2004;29: 435-441.
19- Yektaş A. Perkütan Laser Disk Dekompresyon ve Perkütan Hidrodiskektominin Lomber Disk Protrüzyon ve Bulgingi Olan Hastalarda Etkinliğinin Değerlendirilmesi. Sinir Sistemi Cerrahisi Der. 2015; 5(1-2):8-18.