Department of Orthopaedic Surgery, Japan Red Cross Aichi Medical Center Nagoya Daini Hospital, Myokencho 2-9, Syowa-ku, Nagoya, Aichi, 466-8650, Japan.
Department of Orthopaedic Surgery, Japan Red Cross Aichi Medical Center Nagoya Daini Hospital, Myokencho 2-9, Syowa-ku, Nagoya, Aichi, 466-8650, Japan.
J Orthop Sci. 2023 Sep;28(5):976-983. doi: 10.1016/j.jos.2022.08.001. Epub 2022 Aug 25.
Lumbar disc herniation (LDH) is a common cause of low back pain and is associated with degeneration of the nucleus pulposus causing nerve root compression. Chemonucleolysis of the nucleus pulposus with condoliase is a low-invasive treatment for LDH. The purpose of this study was to investigate changes in Pfirrmann criteria, which are used to evaluate disc degeneration, after injection of condoliase into a herniated intervertebral disc, and to identify factors associated with disc degeneration at 3 months post-injection.
Medical records and radiographic findings were reviewed retrospectively for 127 patients with LDH (88 male, 39 female, mean age: 46.6 ± 17.1 years, mean follow-up: 9.8 ± 7.8 months) who underwent chemonucleolysis with intradiscal condoliase injection at our center since September 2018. Condoliase (1.25 U/mL; 1 mL volume) was injected toward the middle of the affected intervertebral nucleus pulposus using a 21-gauge disc-puncture needle.
Cases in which the Pfirrmann grade did and did not progress in the 3 months after the injection were included in groups P (progression, n = 49) and NP (non-progression, n = 78), respectively. Logistic regression analysis of progression of Pfirrmann grade post-injection showed significant associations with age <40 years (p = 0.013, odds ratio (OR): 3.69, 95% confidence interval (CI): 1.32-10.31), Pfirrmann Grade II or III at baseline (p = 0.021, OR: 3.51, 95% CI: 1.24-9.64), and a high-intensity MRI signal in the herniation (p = 0.047, OR: 2.97, 95% CI: 1.03-8.87). Patients in group P had significantly higher rates of disc height decrease ≥20%, reduced herniated disc size, and improved VAS for pain, but both groups had significant decreases in pain. No cases had anaphylactic shock or neurologic sequelae.
These results show the safety and efficacy of chemonucleolysis with condoliase for treatment of painful LDH. Progression of Pfirrmann criteria on MRI at 3 months after injection was significantly associated with an improved clinical outcome.
腰椎间盘突出症（LDH）是腰痛的常见原因，与导致神经根受压的髓核变性有关。用胶原酶化学核溶解治疗椎间盘突出症是一种微创治疗方法。本研究的目的是探讨在注射胶原酶治疗突出的椎间盘后，用于评估椎间盘退变的 Pfirrmann 标准的变化，并确定与注射后 3 个月椎间盘退变相关的因素。
回顾性分析了 2018 年 9 月以来在我中心接受椎间盘内胶原酶注射化学核溶解治疗的 127 例 LDH 患者（88 例男性，39 例女性；平均年龄：46.6±17.1 岁；平均随访：9.8±7.8 个月）的病历和影像学检查结果。使用 21 号椎间盘穿刺针将浓度为 1.25 U/mL（1mL 体积）的胶原酶注射到病变椎间盘的中央。
将注射后 3 个月 Pfirrmann 分级进展和不进展的病例分别纳入 P 组（进展，n=49）和 NP 组（无进展，n=78）。注射后 Pfirrmann 分级进展的 Logistic 回归分析显示，年龄<40 岁（p=0.013，优势比（OR）：3.69，95%置信区间（CI）：1.32-10.31）、基线时 Pfirrmann 分级 II 或 III 级（p=0.021，OR：3.51，95% CI：1.24-9.64）和突出物的高信号 MRI（p=0.047，OR：2.97，95% CI：1.03-8.87）与注射后 Pfirrmann 分级进展显著相关。P 组患者的椎间盘高度降低≥20%、突出椎间盘体积减小和疼痛视觉模拟评分（VAS）改善的比例显著更高，但两组患者的疼痛均显著减轻。无病例发生过敏休克或神经后遗症。
这些结果表明胶原酶化学核溶解治疗疼痛性 LDH 是安全有效的。注射后 3 个月 MRI 上 Pfirrmann 标准的进展与临床疗效的改善显著相关。
