Short-term clinical and radiographic outcomes of chemonucleolysis with condoliase for painful lumbar disc herniation and analysis regarding intradiscal injection area

• Published in: Neurosurgical review Vol. 46; no. 1; p. 59
• Main Authors: Ohtonari, Tatsuya, Torii, Rina, Noguchi, Shohei, Kitagawa, Takehiro, Nishihara, Nobuharu
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 23.02.2023
• Subjects: Adult; Humans; Intervertebral Disc Chemolysis - adverse effects; Intervertebral Disc Displacement - surgery; Low Back Pain - etiology; Lumbar Vertebrae - surgery; Male; Medicine; Medicine & Public Health; Neurosurgery; Pain Management; Retrospective Studies; Treatment Outcome; Chondroitin sulfate ABC endolyase; Chemonucleolysis; Condoliase; Lumbar disc herniation; Herniated disc
• ISSN: 1437-2320; 1437-2320
• DOI: 10.1007/s10143-023-01966-w

Percutaneous chemonucleolysis with condoliase has been available for painful lumbar disc herniation since 2018 in Japan. This study investigated clinical and radiographic outcomes three months after the administration because the secondary surgical removal is most required during this period for the insufficient pain relief, and analyzed whether the differences of intradiscal injection areas affected the clinical outcomes. We retrospectively investigated 47 consecutive patients (males, 31; median age, 40 years) three months after the administration. Clinical outcomes were evaluated using the Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ), a visual analog scale (VAS) score for low back pain, and VAS scores for pains and numbness in the lower limbs. Radiographic outcomes were analyzed in 41 patients, using parameters such as mid-sagittal disc height and maximal protrusion length of herniation on MRI preoperatively and at the final follow-up. Postoperative median evaluation period was 90 days. The effective rate of low back pain based on the pain-related disorders at baseline and the last follow-up in the JOABPEQ reached 79.5%. The postoperative proportion of VAS scores recovery ≥ 2 points and ≥ 50% for pains in the lower limbs were 80.9% and 66.0%, respectively, revealing satisfactory effectiveness. Preoperative median mid-sagittal disc height significantly reduced from 9.5 to 7.6 mm postoperatively. There were no significant differences in pain relief in the lower limbs by injection areas in the center and the dorsal 1/3rd near the herniation of nucleus pulposus. Chemonucleolysis with condoliase revealed satisfactory short-term outcomes after the administration regardless of intradiscal injection areas.