2020 Volume 11 Issue 6 Pages 931-935
In 2018, condoliase was approved as a less-invasive intermediate treatment for lumbar disc herniation (LDH), positioned between conservative treatment and surgery. Chemonucleolysis involves the injection of an enzyme into the intervertebral disc to dissolve the nucleus pulposus, thereby reducing intradiscal pressure on the nerve root and improving LDH symptoms. Condoliase is a foreign protein, and so the risk of anaphylaxis cannot be excluded. Patients should avoid unnecessary treatment. Therefore, it is important to predict the efficacy of condoliase before intermediate treatment. The aim of the present study was to determine an imaging factor that can be used to predict favorable clinical results.
Materials and Methods: We retrospectively studied 10 patients who received an intradiscal injection of condoliase and were followed for a 12-week period after administration between August 2018 and December 2018. Clinical evaluation involved the use of Oswestry Disability Index (ODI), with the omission of section 8. Disc degeneration was graded by Pfirrmann classification. We measured the disc height, dural sac area, and dissolved herniated mass on MRI. The effective group on imaging was defined as patients with a dissolved herniated mass area of more than 20 mm2.
Results: The mean ODIs at the baseline and week 12 were 34.2 and 18.4, respectively. The mean area of the dissolved herniated mass was 7.8 mm2, and there were 4 patients in the effective group on imaging. The median of the effective group on imaging was significantly lower than that of the non-effective group (P<0.05). The area of the dissolved herniated mass was significantly correlated with the disc degeneration grade (r=-0.65, P<0.05).
Conclusion: Condoliase was more effective against mild to early disc degeneration because it may reduce the size of the intervertebral disc by degrading glycosaminoglycans of proteoglycans in the nucleus pulposus, thereby reducing the water content and intradiscal pressure.
