Outcome of intradiscal condoliase injection therapy for patients with recurrent lumbar disc herniation

다국어 초록 (Multilingual Abstract)

Study Design: Retrospective cohort study.Purpose: This study aimed to compare data from patients who received intradiscal condoliase (chondroitin sulfate ABC endolyase) injection for primary lumbar disc herniation (LDH) and recurrent LDH.Overview of Literature: Chemonucleolysis with condoliase for LDH is a treatment with relatively good results and a high safety profile; however, few studies have reported recurrence after LDH surgery.Methods: The study participants were 249 patients who underwent intradiscal condoliase injection for LDH at nine participating institutions, including 241 patients with initial LDH (group C) and eight with recurrent LDH (group R). Patient characteristics including age, sex, body mass index, disease duration, intervertebral LDH level, smoking history, and diabetes history were evaluated. Low back pain/leg pain Numerical Rating Scale (NRS) scores and the Oswestry Disability Index (ODI) were used to evaluate clinical symptoms before treatment and at 6 months and 1 year after treatment.Results: Low back pain NRS scores (before treatment and at 6 months and 1 year after treatment, respectively) in group C (4.9 → 2.6 → 1.8) showed significant improvement until 1 year after treatment. Although a tendency for improvement was observed in group R (3.5 → 2.8 → 2.2), no significant difference was noted. Groups C (6.6 → 2.4 → 1.4) and R (7.0 → 3.1 → 3.2) showed significant improvement in the leg pain NRS scores after treatment. Group C (41.4 → 19.5 → 13.7) demonstrated significant improvement in the ODI up to 1 year after treatment; however, no significant difference was found in group R (35.7 → 31.7 → 26.4).Conclusions: Although intradiscal condoliase injection is less effective for LDH recurrence than for initial cases, it is useful for improving leg pain and can be considered a minimally invasive and safe treatment method.

참고문헌 (Reference)

1 Hamai A, "Two distinct chondroitin sulfate ABC lyases : an endoeliminase yielding tetrasaccharides and an exoeliminase preferentially acting on oligosaccharides" 272 : 9123-9130, 1997

2 Funayama T, "Two cases of lateral lumbar disc herniation successfully treated with intradiscal condoliase injection" 5 : 437-441, 2020

3 Okada E, "The effectiveness of chemonucleolysis with condoliase for treatment of painful lumbar disc herniation" 26 : 548-554, 2021

4 Lurie JD, "Surgical versus nonoperative treatment for lumbar disc herniation : eightyear results for the spine patient outcomes research trial" 39 : 3-16, 2014

5 Yuce I, "Surgical outcome and efficacy of lumbar microdiscectomy technique with preserving of ligamentum flavum for recurrent lumbar disc herniations" 63 : 43-47, 2019

6 Nakajima H, "Short-term outcome and predictors of therapeutic effects of intradiscal condoliase injection for patients with lumbar disc herniation" 5 : 264-271, 2020

7 Miwa S, "Risk factors of recurrent lumbar disk herniation : a single center study and review of the literature" 28 : E265-E269, 2015

8 Dai LY, "Recurrent lumbar disc herniation after discectomy : outcome of repeat discectomy" 64 : 226-231, 2005

9 Swartz KR, "Recurrent lumbar disc herniation" 15 : E10-, 2003

10 Nolte MT, "Patients undergoing revision microdiskectomy for recurrent lumbar disk herniation experience worse clinical outcomes and more revision surgeries compared with patients undergoing a primary microdiskectomy" 27 : e796-e803, 2019

11 Pfirrmann CW, "Magnetic resonance classification of lumbar intervertebral disc degeneration" 26 : 1873-1878, 2001

12 Lewis PJ, "Long-term prospective study of lumbosacral discectomy" 67 : 49-53, 1987

13 Yorimitsu E, "Long-term outcomes of standard discectomy for lumbar disc herniation : a follow-up study of more than 10 years" 26 : 652-657, 2001

14 Hirai T, "Intradiscal injection with condoliase(chondroitin sulfate ABC endolyase)for painful radiculopathy caused by lumbar disc herniation" 6 : 252-260, 2021

15 Fukui H, "Intradiscal condoliase injection therapy for recurrent lumbar disc herniation : case series and literature review" 59 : 1561-, 2023

16 Parker SL, "Incidence of low back pain after lumbar discectomy for herniated disc and its effect on patient-reported outcomes" 473 : 1988-1999, 2015

17 Sugimura T, "Experimental chemonucleolysis with chondroitinase ABC in monkeys" 21 : 161-165, 1996

18 Kato F, "Experimental chemonucleolysis with chondroitinase ABC" (253) : 301-308, 1990

19 Vik A, "Eight year outcome after surgery for lumbar disc herniation : a comparison of reoperated and not reoperated patients" 143 : 607-611, 2001

20 Takaki S, "Cost-effectiveness analysis of intradiscal condoliase injection vs. surgical or conservative treatment for lumbar disc herniation" 26 : 233-242, 2023

21 Chiba K, "Condoliase for the treatment of lumbar disc herniation : a randomized controlled trial" 43 : E869-E876, 2018

22 Fjeld OR, "Complications, reoperations, readmissions, and length of hospital stay in 34639 surgical cases of lumbar disc herniation" 101-B : 470-477, 2019

23 Yao Y, "Comparison of three minimally invasive spine surgery methods for revision surgery for recurrent herniation after percutaneous endoscopic lumbar discectomy" 100 : 641-647, 2017

24 Banno T, "Clinical outcome of condoliase injection treatment for lumbar disc herniation : indications for condoliase therapy" 26 : 79-85, 2021

25 Ishibashi K, "Chemonucleolysis with chondroitin sulfate ABC endolyase for treating lumbar disc herniation : exploration of prognostic factors for good or poor clinical outcomes" 56 : 627-, 2020

26 Matsuyama Y, "A multicenter, randomized, double-blind, dose-finding study of condoliase in patients with lumbar disc herniation" 28 : 499-511, 2018

27 Davis RA, "A long-term outcome analysis of 984 surgically treated herniated lumbar discs" 80 : 415-421, 1994

28 Funayama T, "A case of postoperative recurrent lumbar disc herniation conservatively treated with novel intradiscal condoliase injection" 2022 : 3656753-, 2022