Kagami Yujiro, Nakashima Hiroaki, Segi Naoki, Shinjo Ryuichi, Imagama Shiro
Department of Orthopedic Surgery, Anjo Kosei Hospital, Aichi, Japan.
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan.
Spine Surg Relat Res. 2023 Mar 13;7(4):363-370. doi: 10.22603/ssrr.2022-0189. eCollection 2023 Jul 27.
This study aimed to evaluate the efficacy of condoliase injection therapy (CIT) for lateral lumbar disc herniation (LLDH).
This retrospective study included 157 of 180 enrolled patients (70 males, 87 females; mean age: 52.6±16.9 years). These patients were divided into two groups (group L: LLDH, group M: medial LDH [subligamentous and transligamentous]). From baseline to 1 year after injection (final follow-up), leg pain was assessed using the visual analog scale (VAS) and the Japanese Orthopedic Association (JOA) scoring for CIT's clinical efficacy of CIT. Radiography and magnetic resonance imaging conducted before and 3 months after the injection were assessed. Patients with a VAS improvement of ≥50% at the final follow-up were defined as responders. The responder and nonresponder LLDH groups were also compared.
Groups L and M showed comparable responder rates (75.0% and 77.4%, respectively) (=0.80). VAS and JOA scores at 1 year showed no significant differences between the groups (=0.82 and 0.80, respectively). VAS score at 1 month after injection reduced considerably in the responder group compared with that in the nonresponder group (19.7 vs. 66.0, <0.01) and continued to decrease at the last follow-up (3.5 vs. 52.0, <0.001). Nonresponders had significantly lower disc heights after 3 months. However, intervertebral instability, alignment, and disc degeneration did not differ between the responders and nonresponders.
The response rate of CIT for LLDH was comparable to that for medial LDH. Therefore, CIT is an effective treatment for LLDH.
本研究旨在评估condoliase注射疗法(CIT)治疗外侧腰椎间盘突出症(LLDH)的疗效。
本回顾性研究纳入了180例登记患者中的157例(男性70例,女性87例;平均年龄:52.6±16.9岁)。这些患者被分为两组(L组:LLDH,M组:内侧腰椎间盘突出症[韧带下型和经韧带型])。从基线到注射后1年(最终随访),使用视觉模拟量表(VAS)和日本骨科协会(JOA)评分评估腿痛情况,以评价CIT的临床疗效。对注射前和注射后3个月进行的X线摄影和磁共振成像进行评估。最终随访时VAS改善≥50%的患者被定义为反应者。还对反应者和非反应者的LLDH组进行了比较。
L组和M组的反应率相当(分别为75.0%和77.4%)(=0.80)。两组在1年时的VAS和JOA评分无显著差异(分别为=0.82和0.80)。与非反应者组相比,反应者组注射后1个月时的VAS评分显著降低(19.7对66.0,<0.01),并在最后随访时继续下降(3.5对52.0,<0.001)。非反应者在3个月后的椎间盘高度显著较低。然而,反应者和非反应者之间的椎间不稳定、对线和椎间盘退变并无差异。
CIT治疗LLDH的反应率与内侧腰椎间盘突出症相当。因此,CIT是治疗LLDH的有效方法。