Prognostic Factors of Chemonucleolysis with Condoliase for Lumbar Disc Herniation

Abstract

Introduction: Intradiscal injection therapy using condoliase is a new minimally invasive treatment for lumbar disc herniation. This study aimed to examine the short-term outcomes of intradiscal condoliase injection for lumbar disc herniation and reveal the factors influencing the effectiveness of this therapy.

Methods: Sixty-nine patients (48 men and 21 women), who were treated with condoliase injections and followed-up for >3 months, were enrolled in this prospective study. Their mean age was 45.0 years (range, 17-89 years). We investigated the Visual Analog Scale scores for low back and leg pain as clinical assessments, and the herniation size on magnetic resonance imaging as radiological assessments, preinjection, and 1 month and 3 months postinjection. An improvement of ≥50% in the Visual Analog Scale (VAS) score for leg pain was considered to indicate effectiveness.

Results: The mean VAS score for low back pain notably improved from 5.1 preinjection to 2.8 postinjection, and that of leg pain notably improved from 6.9 to 2.4. The herniation size decreased from 53.2 mm² preinjection to 24.4 mm² postinjection. Fifty-two patients (75%) at 3 months postinjection showed improvement, and compared with those who did not show effectiveness, these patients were significantly younger (40.9±15.1 vs. 57.5±16.8 years, t-test, p = 0.0011) and positive tension sign was seen in effective cases (86.5% vs. 58.8%, p = 0.014). Furthermore, the effective group improved the VAS score for the lower leg at 1 month postinjection (−4.5±2.7 vs. −0.2±2.1, t-test, p < 0.0001).

Conclusions: Condoliase injection significantly improved the VAS scores for low back pain and leg pain. Young age, positive tension sign, and improvement in the VAS score for the lower leg after 1month were associated with effectiveness at 3 months postinjection.