Cervicogenic dizziness alleviation after coblation discoplasty: a retrospective study

Abstract

Objective: Little is known about the therapeutic relationship between coblation discoplasty and cervicogenic dizziness (CGD). CGD can be caused by abnormal proprioceptive inputs from compressed nerve roots, intradiscal mechanoreceptors and nociceptors to the vestibulospinal nucleus in the degenerative cervical disc. The aim was to analyze the efficacy of coblation discoplasty in CGD through intradiscal nerve ablation and disc decompression in a 12-month follow-up retrospective study.

Methods: From 2015 to 2019, 42 CGD patients who received coblation discolplasty were recruited as the surgery group, and 22 CGD patients who rejected surgery were recruited as the conservative group. Using intent-to-treat (ITT) analysis, we retrospectively analyzed the CGD visual analogue scale (VAS), neck pain VAS, CGD frequency score, and the CGD alleviation rating throughout a 12-month follow-up period.

Results: Compared with conservative intervention, coblation discoplasty revealed a better recovery trend with effect sizes of 1.76, 2.15, 0.92, 0.78 and 0.81 in CGD VAS, and effect sizes of 1.32, 1.54, 0.93, 0.86 and 0.76in neck pain VAS at post-operative 1 week, and 1, 3, 6, 12 months, respectively. The lower CGD frequency score indicated fewer attacks of dizziness until postoperative 3 months (p < 0.01). At post-operative 12 months, the coblation procedure showed increased satisfactory outcomes of CGD alleviation rating (p < .001, -1.00 of effect size).

Conclusions: Coblation discoplasty significantly improves the severity and frequency of CGD, which is important inbridging unresponsive conservative intervention and open surgery.Key messagesThere is a correlation between the degenerative cervical disc and cervicogenic dizziness (CGD).CGD can be caused by abnormal proprioceptive inputs from a compressed nerve root and intradiscal mechanoreceptors and nociceptors to the vestibulospinal nucleus in the degenerative cervical disc.Cervical coblation discoplasty can alleviate CGD through ablating intradiscal nerve endings and decompressing the nerve root.

Keywords: Cervicogenic dizziness; cervicogenic vertigo; coblation discoplasty; coblation nucleoplasty.

Figure 1.

The pathological pathway of cervical dizziness between cervical structures and vestibulospinal nucleus. Pathway 1: originating from mechanoreceptors in the facet joint; pathway 2: originating from muscle spindles; pathway 3: originating from mechanoreceptors in intradiscal endings.

Figure 2.

Three distinct ablation regions in the degenerative disc. (a) Mechanoreceptors innervate from annulus into nucleus, 1-plot indicates the margin of annulus, 2-plot indicates the boundary between annulus and nucleus, and 3-plot indicates the mid-nucleus; (b–d) Ablation region is in the margin of the annulus, the boundary between annulus and nucleus, and the mid-nucleus, respectively; (e–g) In C4–5 level, the ablation region is in the margin of the annulus, the boundary between annulus and nucleus, and the mid-nucleus under fluoroscopic guidance, respectively.

Figure 3.

The efficacy outcomes after coblationdiscoplasty in 12 months follow-up. (a) Comparison of CDG VAS between two groups; (b) Comparison of neck pain VAS between two groups; (c) Comparison of CGD frequency score between two groups; (d) Comparison of CGD alleviation rating between two groups. B: baseline; P: post-operative; w: week; m: month; “__” indicates medium; “--->” indicates 25th quartile; “–>” indicates 75th quartile.