Medicina (Sep 2022)

Multicenter Retrospective Analysis of Intradiscal Condoliase Injection Therapy for Lumbar Disc Herniation

  • Yusuke Oshita,
  • Daisuke Matsuyama,
  • Daisuke Sakai,
  • Jordy Schol,
  • Eiki Shirasawa,
  • Haruka Emori,
  • Kazuyuki Segami,
  • Shu Takahashi,
  • Kazumichi Yagura,
  • Masayuki Miyagi,
  • Wataru Saito,
  • Takayuki Imura,
  • Toshiyuki Nakazawa,
  • Gen Inoue,
  • Akihiko Hiyama,
  • Hiroyuki Katoh,
  • Tsutomu Akazawa,
  • Koji Kanzaki,
  • Masato Sato,
  • Masashi Takaso,
  • Masahiko Watanabe

DOI
https://doi.org/10.3390/medicina58091284
Journal volume & issue
Vol. 58, no. 9
p. 1284

Abstract

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Background and Objectives: Intradiscal injection of Condoliase (chondroitin sulfate ABC endolyase), a glycosaminoglycan-degrading enzyme, is employed as a minimally invasive treatment for lumbar disc herniation (LDH) and represents a promising option between conservative treatment and surgical intervention. Since its 2018 approval in Japan, multiple single-site trails have highlighted its effectiveness, however, the effect of LDH types, and influences of patient age, sex, etc., on treatment success remains unclear. Moreover, data on teenagers and elderly patients has not been reported. In this retrospective multi-center study, we sought to classify prognostic factors for successful condoliase treatment for LDH and assess its effect on patients Materials and Methods: We reviewed the records of 137 LDH patients treated through condoliase at four Japanese institutions and assessed its effectiveness among different age categories on alleviation of visual analog scale (VAS) of leg pain, low back pain and numbness, as well as ODI and JOA scores. Moreover, we divided them into either a “group-A” category if a ≥50% improvement in baseline leg pain VAS was observed or “group-N” if VAS leg pain improved Results: Fifty-five patients were classified as group-A (77.5%) and 16 patients were allocated to group-N (22.5%). A significant difference in Pfirrmann classification was found between both cohorts, with grade IV suggested to be most receptive. A posterior disc angle > 5° was also found to approach statical significance. In all age groups, average VAS scores showed improvement. However, 75% of adolescent patients showed deterioration in Pfirrmann classification following treatment. Conclusions: Intradiscal condoliase injection is an effective treatment for LDH, even in patients with large vertebral translation and posterior disc angles, regardless of age. However, since condoliase imposes a risk of progressing disc degeneration, its indication for younger patients remains controversial.

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