Zhang Hao, Zhang Chi, Li Lin, Hu Ming-Liang, Zhao Jian-Ning, Zheng Zhang, Ding Wen-Feng
Department of Radiology, Dianjiang People's Hospital of Chongqing, Chongqing, China.
Chongqing Yangjiaping Middle School, Chongqing, China.
Front Med (Lausanne). 2025 Jan 8;11:1522568. doi: 10.3389/fmed.2024.1522568. eCollection 2024.
Lumbar disc herniation (LDH) affects millions globally, with annual healthcare costs exceeding $100 billion in the United States alone, driving increasing interest in minimally invasive radiological interventions as treatment alternatives. This narrative review examines developments in collagenase chemonucleolysis for LDH, integrating a literature analysis with clinical experience. Key advancements include the transition from single-agent to combination therapies, exploration of diverse injection routes, and the progression from C-arm fluoroscopy to multi-slice CT guidance. The synergistic use of collagenase, oxygen-ozone, and anti-inflammatory analgesics has enhanced efficacy. Safety measures such as aspiration tests, contrast agent tests, and lidocaine tests implemented to mitigate procedural risks. However, challenges persist, including non-standardized dosages and potential complications arising from intradiscal injections. Future research should focus on establishing accreditation systems, refining patient selection criteria, optimizing drug dosages, and exploring advanced image-guided technologies. While chemonucleolysis offers advantages such as minimal invasiveness and cost-effectiveness, its complexity necessitates a multidisciplinary approach. Key findings demonstrate that combination therapy achieves superior outcomes compared to monotherapy, with long-term efficacy rates reaching 90% and 6-month success rates of 95%. Additionally, CT guidance has significantly improved procedural precision and safety compared to traditional fluoroscopy. This review provides insights for clinicians and researchers, highlighting the potential of chemonucleolysis in LDH management to ensure its safe and effective integration into mainstream treatment protocols.
腰椎间盘突出症（LDH）在全球影响着数百万人，仅在美国，每年的医疗费用就超过1000亿美元，这使得人们对作为治疗替代方案的微创放射介入治疗的兴趣日益浓厚。这篇叙述性综述结合文献分析与临床经验，审视了胶原酶化学溶核术治疗LDH的发展情况。主要进展包括从单一药物治疗向联合治疗的转变、对多种注射途径的探索，以及从C形臂荧光透视引导向多层CT引导的发展。胶原酶、臭氧和抗炎镇痛药的协同使用提高了疗效。为降低手术风险实施了诸如回抽试验、造影剂试验和利多卡因试验等安全措施。然而，挑战依然存在，包括剂量不规范以及椎间盘内注射可能引发的并发症。未来的研究应聚焦于建立认证体系、完善患者选择标准、优化药物剂量以及探索先进的影像引导技术。虽然化学溶核术具有微创性和成本效益等优势，但其复杂性需要采用多学科方法。主要研究结果表明，联合治疗比单一疗法取得了更好的效果，长期有效率达到90%，6个月成功率为95%。此外，与传统荧光透视相比，CT引导显著提高了手术的精确性和安全性。这篇综述为临床医生和研究人员提供了见解，突出了化学溶核术在LDH治疗中的潜力，以确保其安全有效地融入主流治疗方案。
