Percutaneous plasma disc decompression through a lower surgical approach for the treatment of cervicogenic headache in patients with cervical spondylotic radiculopathy: A retrospective cohort study.

Cervical spondylotic radiculopathy (CSR) is the most common type of cervical spondylosis, frequently accompanied by cervicogenic headache (CEH). Percutaneous plasma disc decompression (PPDD) and pulsed radiofrequency (PRF) are minimally invasive techniques targeting cervical intervertebral discs or cervical nerves, and have been proven to be effective methods for treatment of CSR and CEH. The present study aimed to evaluate clinical efficacy and practicality of percutaneous plasma disc decompression (PPDD) via a lower surgical approach for the treatment of cervicogenic headache (CEH) and upper extremity radicular pain by analyzing clinical outcomes of patients with cervical spondylotic radiculopathy (CSR) undergoing PPDD and pulsed radiofrequency (PRF). Clinical data of patients with CSR who received PPDD (n=79) or PRF (n=92) at Shanghai Traditional Chinese Medicine Hospital (Shanghai, China) and Jiashan County People's Hospital (Jiaxing, China) from January 2022 to December 2022 were retrospectively collected and analyzed. The surgical site and procedure, bleeding volume, preoperative analgesic use and upper extremity symptoms, history of nerve block treatment and duration of disease were recorded, as well as relevant postoperative complications (infection, hematoma, nerve injury). The therapeutic effects [NRS (numeric rating scale) and NDI (neck disability index) score, and CEH remission rate at 1, 3 and 6 months after treatment] of both surgical methods were investigated using the telephone follow-up. CEH remission rates at 1, 3 and 6 months after surgery in the PPDD group were significantly higher than in the PRF group (78.8 vs. 43.5, P=0.016; 84.8 vs. 34.8, P=0.003 and 75.8 vs. 26.1%, P=0.005, respectively). The PPDD group showed higher NRS scores than the PRF group at 1 month after surgery (3 vs. 2, P<0.0001) and lower NRS scores than the PRF group at 6 months after surgery (2 vs. 3, P<0.0001). NDI scores in the PPDD group were significantly lower than those in the PRF group at 1, 3 and 6 months after surgery (15.49 vs. 20.05, P=0.002; 16.06 vs. 20.10, P=0.003 and 9.90 vs. 13.80, P=0.001, respectively). There was no significant difference in postoperative complication rate between the two groups (P>0.999). PPDD could significantly relieve CEH symptoms and upper extremity radicular pain in patients with CSR treated via a lower surgical approach and PPDD was more effective than PRF for long-term CEH remission and pain alleviation.