Construction and Preliminary Validation of a CT-Guided Precision Targeted Interventional Model Based on Reverse Design for Cervical Disc Extrusion

<title>Abstract</title> <p> <bold>Objective</bold> Based on the advantages and limitations of existing therapeutic regimens for cervical disc extrusion, this study constructs a novel precision-targeted interventional protocol guided by computed tomography (CT), combining radiofrequency (RF), ozone, and collagenase centered on symptomatic extruded disc fragments. The technical feasibility of this model is preliminarily verified. <bold>Background</bold> Cervical disc extrusion is characterized by nucleus pulposus herniation through the annulus fibrosus into the spinal canal or intervertebral foramen, causing mechanical compression and inflammatory irritation of nerve roots and the spinal cord. An ideal treatment should simultaneously decompress symptomatic lesions, eliminate local inflammation, and preserve intact spinal structures. Nevertheless, surgery, conservative management, and conventional collagenase interventions all possess inherent drawbacks. Open resection achieves thorough decompression yet disrupts native spinal anatomy; conservative therapy protects tissue integrity but fails to resolve mass-like extruded fragments; traditional intradiscal or epidural collagenase injection suffers from target deviation and uncontrolled drug diffusion. This study therefore proposes a core research question: can CT guidance enable direct intra-extrusion collagenase injection for precise lesion ablation? <bold>Methods</bold> A reverse design framework was adopted: optimal therapeutic endpoints were defined first, followed by stepwise development of a complete interventional workflow. Two consistency criteria were enforced for patient enrollment: radiological consistency and clinical consistency. A triple-modality regimen consisting of personalized CT-guided puncture, RF pretreatment, ozone administration, and targeted collagenase injection was implemented. Four representative anatomical subtypes (paracentral, foraminal, posterior migrated, and anatomically obscured extrusion) were recruited to validate technical operability. <bold>Results</bold> All four patients successfully completed the full interventional procedure. Accurate lesion localization, individualized access planning, focal drug delivery, and controllable injection safety margins were achieved intraoperatively. No severe procedure-related complications occurred. All patients experienced varying degrees of relief from radicular symptoms during follow-up. Serial MRI demonstrated shrinkage of extruded fragments and alleviated neural compression without extensive injury to unaffected intervertebral discs. <bold>Conclusions</bold> This triple-modality protocol is not a simple combination of existing techniques but a paradigm shift in therapeutic logic. It integrates the lesion-resecting capacity of surgery, the tissue-preserving concept of conservative care, and the minimally invasive merit of interventional radiology, shifting the therapeutic target from the entire intervertebral disc to symptomatic extruded fragments. The four enrolled cases only serve to validate operability across diverse anatomical presentations rather than provide statistically significant efficacy evidence. Standardized protocols and large-scale cohort studies are required to evaluate long-term safety and efficacy. </p>