Hirai Takashi, Takahashi Takuya, Tanaka Tomoyuki, Motoyoshi Takayuki, Matsukura Yu, Yuasa Masato, Inose Hiroyuki, Yoshii Toshitaka, Okawa Atsushi
Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Spine Surg Relat Res. 2021 Oct 11;6(3):252-260. doi: 10.22603/ssrr.2021-0151. eCollection 2022.
Chemonucleolysis with condoliase (chondroitin sulfate ABC endolyase) has been used to treat patients with lumbar disc herniation (LDH) in Japan since 2018. In this study, we retrospectively investigated clinical outcomes in patients who received an intradiscal condoliase injection for LDH and sought to identify significant predictors of good outcome.
Indications for treatment were as follows: (1) unilateral leg pain with or without back pain, (2) nerve root compression caused by LDH confirmed on magnetic resonance imaging (MRI), and (3) leg pain resistant to at least 1 month of conservative treatment, including medication, nerve root block, or physical therapy. Patients with motor weakness or a history of severe allergy were excluded, as were those with the foraminal or sequestrated type of LDH. The injection was defined as effective if the numeric rating scale score for leg pain improved by ≥50% at 6 months post-treatment.
A total of 52 patients (mean age, 45.0 years) were enrolled and classified according to whether the injection was effective (E group, n=40, 76.9%) or less effective (L group, n=9, 17.3%). Three patients (5.8%) underwent herniotomy for residual pain within 6 months of the injection. There were no severe adverse events. Reduction of herniation was seen on MRI more often in the E group than in the L group. The effectiveness in patients with transligamentous LDH was similar to that in patients with subligamentous LDH. High-intensity signal change in the area of LDH on pretreatment T2-weighted MRI was a significant predictor of successful leg pain relief.
An intradiscal condoliase injection was a safe and effective treatment for painful radiculopathy caused by LDH. Leg pain was more likely to improve in patients with high-intensity signal change in the area of LDH before treatment.
自2018年以来，在日本已使用含软骨素酶（硫酸软骨素ABC内切酶）的化学髓核溶解术治疗腰椎间盘突出症（LDH）患者。在本研究中，我们回顾性调查了接受椎间盘内注射软骨素酶治疗LDH患者的临床结局，并试图确定良好结局的重要预测因素。
治疗指征如下：（1）伴有或不伴有背痛的单侧腿痛；（2）磁共振成像（MRI）证实由LDH引起的神经根受压；（3）对包括药物治疗、神经根阻滞或物理治疗在内的至少1个月保守治疗有抵抗的腿痛。排除有运动无力或严重过敏史的患者，以及椎间孔型或游离型LDH患者。如果治疗后6个月时腿痛的数字评分量表评分改善≥50%，则注射被定义为有效。
共纳入52例患者（平均年龄45.0岁），并根据注射是否有效分为有效组（E组，n = 40，76.9%）或效果较差组（L组，n = 9，17.3%）。3例患者（5.8%）在注射后6个月内因残留疼痛接受了疝修补术。未发生严重不良事件。与L组相比，E组MRI上更常观察到椎间盘突出缩小。经韧带型LDH患者的有效性与韧带下型LDH患者相似。治疗前T2加权MRI上LDH区域的高强度信号改变是腿痛缓解成功的重要预测因素。
椎间盘内注射软骨素酶是治疗LDH所致疼痛性神经根病的一种安全有效的方法。治疗前LDH区域有高强度信号改变的患者腿痛更有可能改善。
