Banno Tomohiro, Hasegawa Tomohiko, Yamato Yu, Yoshida Go, Arima Hideyuki, Oe Shin, Ide Koichiro, Yamada Tomohiro, Kurosu Kenta, Matsuyama Yukihiro
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Division of Surgical Care, Morimachi, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Spine Surg Relat Res. 2024 Mar 11;8(5):501-509. doi: 10.22603/ssrr.2023-0289. eCollection 2024 Sep 27.
Chemonucleolysis with condoliase is a minimally invasive treatment option for lumbar disk herniation (LDH). However, studies reporting the efficacy of condoliase in patients aged <20 years are scarce. Therefore, the present study aimed to evaluate the efficacy of condoliase therapy for LDH in the aforementioned population.
Condoliase administration was determined based on adequate informed consent. The study enrolled 138 patients (mean age, 41.3±15.4 years) with LDH who received condoliase injections with a follow-up period of 1 year. The patients were divided into Group Y (age, <20 years) and Group A (age, 20-70 years). The clinical outcomes were visual analog scale (VAS) scores for leg and back pain and Oswestry Disability Index (ODI) values. Changes in disk height and degeneration were evaluated. These data were obtained at baseline and at the 3-month and 1-year follow-ups. Condoliase therapy was considered to be effective if it improved the VAS score for leg pain by ≥50% at 1 year from baseline and prevented surgery.
Groups Y and A consisted of 15 and 123 patients, respectively. Condoliase therapy was effective in 9 patients (60.0%) in Group Y and 96 patients (78.0%) in Group A. The rates of Pfirrmann grade deterioration and recovery were substantially higher in Group Y than in Group A (83.3% vs. 45.8% and 50.0% vs. 16.3%, respectively). While the disk height reduction in Group Y was greater at 3 months, it recovered to the same level as that in Group A at 1 year. In Group Y, patients who did not respond to the treatment exhibited a considerably higher preoperative ODI (<0.05).
Chemonucleolysis with condoliase is considered to have limited efficacy in patients aged <20 years. Caution should be taken when managing cases showing lumbar instability or existing disability. While chemonucleolysis with condoliase is a less invasive treatment option for LDH, the administration should be decided upon with sufficient consent considering the potential limited efficacy and disk degeneration.
用胶原酶进行化学髓核溶解术是腰椎间盘突出症（LDH）的一种微创治疗选择。然而，关于胶原酶在20岁以下患者中疗效的研究很少。因此，本研究旨在评估胶原酶疗法对上述人群LDH的疗效。
在获得充分知情同意的基础上确定胶原酶的给药。该研究纳入了138例接受胶原酶注射且随访期为1年的LDH患者（平均年龄41.3±15.4岁）。患者被分为Y组（年龄<20岁）和A组（年龄20 - 70岁）。临床结果为腿部和背部疼痛的视觉模拟量表（VAS）评分以及奥斯威斯功能障碍指数（ODI）值。评估椎间盘高度和退变的变化。这些数据在基线以及3个月和1年随访时获取。如果胶原酶疗法在基线后1年时将腿部疼痛的VAS评分提高≥50%并避免了手术，则认为其有效。
Y组和A组分别有15例和123例患者。胶原酶疗法在Y组9例患者（60.0%）和A组96例患者（78.0%）中有效。Y组中Pfirrmann分级恶化和恢复的发生率显著高于A组（分别为83.3%对45.8%和50.0%对16.3%）。虽然Y组在3个月时椎间盘高度降低更大，但在1年时恢复到与A组相同水平。在Y组中，对治疗无反应的患者术前ODI显著更高（<0.05）。
用胶原酶进行化学髓核溶解术在20岁以下患者中疗效有限。在处理表现为腰椎不稳或已有功能障碍的病例时应谨慎。虽然用胶原酶进行化学髓核溶解术是LDH的一种侵入性较小的治疗选择，但考虑到潜在的疗效有限和椎间盘退变，应在充分知情同意的基础上决定给药。
