The Retrospective Study Of Pfirrmann Grades Treating Contained Disc Lumbar Herniation By Coblation Nucleoplasty

Coblation Nucleoplasty is one of the most effevtive methods for the treatment of lumbar disc herniation(LDH).In China,there are so many patients with LDH received the treatment of coblation nucleoplasty every year. Nuelear magnetic resonance imaging(MRI) is one of the most important method for the clinical assessment of intervertebral disc pathology. Pfirrmann grades is a grading system for lumbar degeneration based on MRI signal inteneity,disc structure,distinction between nucleus and annulus.and disc height. We considered Pfirrmann grades of disc degeneration as an index for prognosis of coblation nucleoplasty.Objective:1.To evaluate the clinical effect of investigate the clinical value of Nucleoplasty for Contained Lumbar disc herniation.2.To exploring the relationship between the curative of nucleoplasty for patients with contained lumbar disc herniation.and to investigate the clinical value of Pfirrmann grades in treating contained lumbar disc herniation.Method:69cases of contained lumbar disc herniation,which were diagnosed by physical examination,CT scanning and/or MR imaging,were treated with nucleoplasty guided by X ray and CT.and60cases were followed up finally with75intervertenral discs, and divided into single-segment group and double-segment group.Pfirrmann grades of single-segment group were recorded before treatment.The numeric rating scales (NRS), Oswestry disability index (ODI) were recorded before the operation, and7d,l month,3months,6months,12months after operation. The improved Macnab criterion was recorded1month and12months after operation to evaluate the clinical efficacy. The secondary operation was recorded as poor.Results:60cases of contained lumbar disc herniation were divided into double-segment group (n=15)and single-segment group(n=45).NRS scores demonstrated statistically significant improvedment at the one,twelve months follow-up visits when compared with baseline values (P<0.05). There were not statistical differences in the VAS and ODI between one month and twelve months (P>0.05).ODI scores was not statistical differences at one month,12months (P>0.05).The pain relief rate of1month and12months was63.5%and60%, respectively. The efficacy rate of1month and12months was76.7%and61.7%, respectively.2.The single-segment group(n=45) was divided into following as:Pfirrmann II group(n=8),Pfirrmann III(n=16),Pfirrmann Ⅳ(n=21),each group was statistical differences in the NRS and ODI between before and after operation (P<0.05).There was not statistical differences in the ODI and NRS between Pirrmann II group and Pfirrmann III group at each follow-up visit (P>0.05).Compared with PfirrmannⅣgrade, both Pfirrmann Ⅱ grade and Ⅲgrade was statistical differences in NRS at one month,three months,six months,twelve months follow-up visits.There was not statistical differences in the ODI among three groups(P <0.05) at7days and preoperation. There was statistical differences in the ODI between III group and IVgroup at three months.six months.twelve months follow-up visits,but not seven days and one month(P<0.05). The difference of ODI between PfirrmannⅢ group and PfirrmannⅣ group was of no statistical significance (P>0.05)at follow-up vasits.except seven days.The pain relief rate of Pfirrmann II group.III group and IV group at12months was79.5%,64%and41%,respectively. The excellent and good rate at12months was100%,90.1%and47.6%,respectively.The total effective rate was100%,93.7%,80.9%, respectively.Spearman rank correlation test show the improved macnab was statistical differences among three groups at twelve months (r=0.500, P<0.001)Conclusions:1.Nucleoplasty were a safe,minimally invasive.simple,effective treatment for contained Lumbar Disc Herniation.2.The curative effect of nucleoplasty was correlative with Pfirrmann levels of hernial disc.The effect rate was higher as Pfirrmann levels of the hernaial disc decreasing.Efficacy in Pfirrmann Ⅱ grade、Ⅲgrade patients were better than that in the PfirrmannⅣgrade patients.3.Pfirrmann grades was valuable for selecting the appropriate case before nucleoplasty.and evaluating efficacy after coblation nucleoplasty.