Effect Of Different Protein Injection Doses On The Therapeutic Effect Of Cyst Aspiration-fibrin Sealant Injection On Symptomatic Tarlov Cyst

Objectives:The aim of the study is to investigate the effect of different injection doses on the therapeutic effect of percutaneous puncture cyst aspiration-fibrin sealant injection in the treatment of symptomatic Tarlov cyst,and to discuss the effectiveness and safety of the operation,so as to further find out the best protein injection dose.Methods:36 patients have met the inclusion criteria were divided into3 groups.Including equal volume injection group,85% volume injection group and 70% injection group.VAS scores and JOA scores were evaluated before operation,24 hours after operation,3 days after operation,1 year after operation and 2 years after operation respectively.VAS improvement rate and JOA improvement rate were calculated at the last follow-up,and MRI examination was perfected to determine the treatment effect and determine whether relapse occurred.Furthermore,the evaluation indexes are compared between groups to evaluate the safety and effectiveness of various treatment schemes.Results: 1)Compared with the non-equal volume injection group,the equal volume injection group has a worse effect on improving the pain(VAS: Group ? vs Group ? 1.73±0.78vs1.08±0.64 P<0.05,Group? vs Group ? 1.73±0.78vs0.83±0.718 P<0.01)and dysfunction(JOA:Group ? vs Group ? 23.36±0.80vs24.46±1.05 P < 0.01,Group ? vs Group ? 23.36±0.80vs24.67±0.88 P < 0.01)of patients 24 hours after operation,and there is no statistical difference between the non-equal volume injection groups(P > 0.05).2)During the 3-day follow-up after surgery,the VAS score of the isovolumic treatment group gradually returned to the level of the non-isovolumic treatment group(VAS: Group? vs Group ? 1.00±0.63vs0.62±0.50 P > 0.05,Group ? vs Group ?1.00±0.63vs0.42±0.51 P<0.05),and there was no statistical difference in JOA score between the isovolumic and non-isovolumic treatment groups(Group? vs Group? vs Group?24.55±0.68vs24.92±0.954vs25.50±0.86 F=4.274 P=0.022).3)There was in VAS(F=0.026 P=0.975)score and JOA(F=0.967 P=0.391)score overall.4)There was no statistical difference in VAS score overall comparison(F=0.700 P=0.504)at 1 year follow-up,JOA score was lower in 70%volume injection group than in 85% volume injection group(JOA: Group? vs Group ? 21.50±2.84vs25.38±2.39 P < 0.05),and there was no statistical difference between equal volume injection group and 85%volume injection group(P>0.05).5)During the follow-up period of 2years after operation,the 70% volume injection group has worse therapeutic effect and lower improvement rate than the equal volume injection group(VAS:Group ? vs Group ? 3.00±2.44vs0.55±0.93 P<0.01,improvement rate of VAS : Group ? vs Group ?56.00%±37.03%vs92.85%±11.87% P<0.01,JOA:Group ? vs Group ?21.50±2.84vs24.55±2.06 P<0.01,improvement rate of JOA:Group ? vs Group? 47.25%±19.67%vs67.71%±18.29% P<0.01)and 85% volume injection group(VAS:Group ? vs Group ? 3.00±2.44vs1.15±1.51 P<0.05,improvement rate of VAS : Group ? vs Group?56.00%±37.03%vs83.16%±21.72% P<0.05,JOA:Group ? vs Group?21.50±2.84vs25.38±25.39 P<0.01,improvement rate of JOA:Group ? vs Group ? 47.25%±19.67%vs74.84±14.08% P < 0.01).There is no statistical difference in VAS score(P<0.05)and JOA score(P<0.05)between the equal volume injection group and 85% volume injection group.Conclusions: 1.C-arm X-ray guided percutaneous puncture cyst aspiration-fibrin sealant injection is effective for the treatment of symptomatic sacral cyst;however,the swelling effect in the process of protein coagulation will lead to transient postoperative pain.2.The recommended dosage of fibrin injection is 85% by volume,which can not only avoid transient pain caused by protein swelling effect after surgery,but also avoid high recurrence rate caused by insufficient protein injectionand incomplete closure of communication holes after surgery.3.Postoperative cerebrospinal fluid leakage may be a risk factor for cyst recurrence.4.Before fibrin injection,the intracapsular fluid should be sucked as much as possible to prevent protein consolidation effect caused by chelation reaction,and the traffic hole cannot be effectively closed.