Hagizawa Hiroki, Kamatani Takashi, Kitaguchi Kazuma, Kashii Masafumi
Department of Orthopedic Surgery, NHO Osaka Minami Medical Center, Kawachinagano, Osaka, Japan.
Department of Orthopedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan.
Neurosurg Rev. 2025 Jan 18;48(1):62. doi: 10.1007/s10143-025-03196-8.
Surgery is often the treatment of choice for lumbar disc herniation (LDH) with severe leg pain. This study aimed to investigate the efficacy of Condoliase chemonucleolysis (CC) in patients who were nonambulatory because of severe leg pain. A total of 58 patients who underwent CC for conservative treatment-resistant LDH were included in this study. Changes in the leg and lower back pain evaluated using the numeric rating scale (NRS) were retrospectively assessed at three time points (1 week, 1 month, and 3 months after treatment). Patients were divided into the ambulatory group (group A) and nonambulatory group (group N) based on their ambulatory status. The clinical and radiological findings including magnetic resonance images were compared between the two groups. Of the 58 patients, 16 (28%) who could not walk independently because of severe leg pain were included in group N. Group N showed significantly higher mean NRS score for leg pain (NRS-LP) before treatment than group A (group N, 7.9; group A, 6.8; p = 0.009). Changes in the mean NRS-LP from pretreatment to 1 week were significantly higher in group N (group N, 5.2; group A, 3.4; p = 0.02). In group N, the mean NRS-LP decreased significantly over time, and 69% of the patients were ambulatory after 1 week, 88% after 1 month, and 94% after 3 months. CC provides early pain relief and can be an immediate treatment option for patients who cannot walk independently because of severe leg pain.
对于伴有严重腿痛的腰椎间盘突出症(LDH)患者,手术通常是首选的治疗方法。本研究旨在调查Condoliase化学髓核溶解术(CC)对因严重腿痛而无法行走的患者的疗效。本研究共纳入了58例因保守治疗无效而接受CC治疗的LDH患者。使用数字评分量表(NRS)评估的腿部和下背部疼痛变化在三个时间点(治疗后1周、1个月和3个月)进行回顾性评估。根据患者的行走状态将其分为行走组(A组)和非行走组(N组)。比较两组的临床和影像学检查结果,包括磁共振成像。58例患者中,16例(28%)因严重腿痛无法独立行走,被纳入N组。N组治疗前的腿部疼痛平均NRS评分(NRS-LP)显著高于A组(N组,7.9;A组,6.8;p = 0.009)。N组从治疗前到1周的平均NRS-LP变化显著高于A组(N组,5.2;A组,3.4;p = 0.02)。在N组中,平均NRS-LP随时间显著下降,69%的患者在1周后能够行走,1个月后为88%,3个月后为94%。CC能提供早期疼痛缓解,对于因严重腿痛而无法独立行走的患者而言,可作为一种即时的治疗选择。