Abstract:Objective To evaluate the clinical efficacy of low-temperature plasma ablation combined with collagenase chemonucleolysis in the treatment of symptomatic adjacent segment degeneration after lumbar fusion surgery. Methods A retrospective analysis was conducted on the clinical data of 63 patients with symptomatic adjacent segment degeneration after lumbar fusion surgery admitted to our department from June 2017 to January 2020, including 42 males and 21 females; 45 cases of single-segment fusion, 14 cases of double-segment fusion, and 4 cases of triple-segment fusion. The location of adjacent segment degeneration (ASD) was the upper intervertebral disc in 52 cases and the lower intervertebral disc in 11 cases, with no accompanying spinal stenosis or segmental instability. Patients were divided into two groups based on the surgical method: the combination group (low-temperature plasma ablation combined with collagenase chemonucleolysis) consisting of 30 cases, and the collagenase group (sole collagenase chemonucleolysis) consisting of 33 cases. Compare and analyze the Visual Analogue Scale (VAS) pain scores of the two groups of patients preoperatively, and postoperatively at 1 day, 1 week, 1 month, 6 months, and 12 months. Compare the Oswestry Disability Index (ODI) of the two groups of patients preoperatively, and postoperatively at 1 month, 6 months, and 12 months. At the 12-month postoperative follow-up, assess the therapeutic effects of both groups using the modified MacNab criteria. Results In the combination group, two cases experienced catheter dislodgement during turning, which was resolved by reinsertion and completion of subsequent treatment. All other patients underwent surgery smoothly. Compared with preoperative levels, VAS scores in both groups significantly decreased at 1 day, 1 week, 1 month, 6 months, and 12 months postoperatively (P < 0.05). The VAS score in the collagenase group at 1 week postoperatively was higher than that at 1 day postoperatively, with a statistically significant difference (t=3.027, P=0.005). Additionally, the difference in VAS scores between the two groups at 1 week postoperatively was statistically significant (2.08±0.75 vs. 2.51±0.62, P < 0.05), while no statistically significant differences were observed at other time points (P > 0.05). The ODI index in both groups at 1 month, 6 months, and 12 months postoperatively significantly decreased compared with preoperative levels, with statistically significant differences (P=0.000), and no statistically significant differences were found between the groups at each time point (P > 0.05). At the 12-month follow-up, the therapeutic outcomes in the combination group were excellent in 18 cases (60%), good in 8 cases (26.67%), and fair in 4 cases (13.33%), with an excellent and good rate of 86.67% (26/30). In the collagenase group, the outcomes were excellent in 17 cases (51.52%), good in 9 cases (27.27%), and fair in 7 cases (21.21%), with an excellent and good rate of 78.79% (26/33). There was no statistically significant difference in the excellent and good rate between the two groups (P=0.498). Conclusion Both low-temperature plasma ablation combined with collagenase chemonucleolysis and sole collagenase chemonucleolysis can significantly alleviate pain in patients with symptomatic adjacent segment degeneration after lumbar fusion surgery, achieving good clinical outcomes. Patients in the collagenase chemonucleolysis group may experience a transient symptom rebound at 1 week postoperatively, but this does not affect the final therapeutic effect.
