Nakajima Hideaki, Watanabe Shuji, Honjoh Kazuya, Kubota Arisa, Matsumine Akihiko
Department of Orthopaedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, Fukui, Japan.
Spine Surg Relat Res. 2024 Mar 11;8(4):362-372. doi: 10.22603/ssrr.2023-0294. eCollection 2024 Jul 27.
Intradiscal condoliase injection for lumbar disc herniation (LDH) was developed in Japan in 2018. The treatment is intermediate between conservative therapy and surgery, and its frequency is increasing. Condoliase is limited to a single application over a lifetime, rendering it important to understand the indications and predictors of its effectiveness. This review aimed to summarize published studies and provide appropriate indications and limitations for appropriate patient selection based on existing findings.
While adhering to PRISMA guidelines, we searched the PubMed, Web of Science, and EMBASE databases to identify articles reporting the clinical outcomes of intradiscal condoliase injection for LDH. Data extraction focused on the effective rate, prognostic factors, and posttreatment imaging changes and was used in the meta-analysis.
Nineteen studies met the inclusion criteria. Our meta-analysis revealed 78% total response, 11% posttreatment surgery, and 42% posttreatment Pfirrmann-classification-grade progression rates. Posttreatment intervertebral disc degeneration was potentially associated with an improved response rate and disc regeneration one year posttreatment, especially in young patients. The Regimen for patients aged <20 and >70 years should be carefully selected, including those with a disease duration of >1 year, recurrent LDH, small-sized LDH, vertebral instability, and inadequate duration (<3 months) of conservative therapy.
Although long-term outcomes and imaging changes must be evaluated owing to the heterogeneity of previous studies, intradiscal condoliase injection is a minimally invasive and cost-effective treatment option for patients with LDH. Treatment indications should be determined after carefully evaluating evidence from previous conservative and surgical treatments.
2018年日本研发了用于治疗腰椎间盘突出症（LDH）的椎间盘内注射condoliase疗法。该治疗介于保守治疗和手术治疗之间，且应用频率不断增加。Condoliase一生仅能使用一次，因此了解其有效性的适应症和预测因素非常重要。本综述旨在总结已发表的研究，并根据现有研究结果为合适的患者选择提供适当的适应症和局限性。
我们遵循PRISMA指南，在PubMed、科学网和EMBASE数据库中进行检索，以识别报告椎间盘内注射condoliase治疗LDH临床结果的文章。数据提取重点关注有效率、预后因素和治疗后影像学变化，并用于荟萃分析。
19项研究符合纳入标准。我们的荟萃分析显示总有效率为78%，治疗后手术率为11%，治疗后Pfirrmann分级进展率为42%。治疗后椎间盘退变可能与治疗后一年的有效率提高和椎间盘再生相关，尤其是在年轻患者中。对于年龄<20岁和>70岁的患者，应谨慎选择治疗方案，包括病程>1年、复发性LDH、小型LDH、椎体不稳定以及保守治疗时间不足（<3个月）的患者。
尽管由于既往研究的异质性，必须评估长期疗效和影像学变化，但椎间盘内注射condoliase是LDH患者的一种微创且经济有效的治疗选择。应在仔细评估既往保守治疗和手术治疗的证据后确定治疗适应症。
