Collagenase chemical lysis versus foraminal endoscopic surgery for lumbar disc herniation: superior efficacy and prognostic factors in postoperative recovery.

OBJECTIVE

To compare the efficacy of collagenase chemonucleolysis (CCNL) and percutaneous transforaminal endoscopic discectomy (PTED) in treating lumbar disc herniation and to identify risk factors affecting patient outcomes.

METHODS

A total of 157 patients with lumbar disc herniation admitted to our hospital between May 2022 and March 2024 were retrospectively analyzed and divided into the PTED group (n = 72) and the CCNL group (n = 85) based on the intervention approach. Clinical data, including age, gender, and BMI, were collected, and procedure-related indicators were recorded. Clinical efficacy was assessed three months postoperatively using the MacNab functional criteria. Pain intensity, lumbar function, and disability were evaluated using the Visual Analog Scale (VAS), Japanese Orthopedic Association assessment (JOA) score, and Oswestry Dysfunction Index (ODI) score, respectively.

RESULTS

No significant differences were observed in baseline data between the two groups (P > 0.05). The CCNL group demonstrated superior outcomes in operative time, intraoperative fluoroscopy time, blood loss, incision size, and postoperative hospital stay (P < 0.001). At 1 week, 1 month, and 3 months after surgery, the CCNL group showed significantly lower VAS scores and better JOA and ODI scores compared to the PTED group (P < 0.05). The total response rate was significantly higher in the CCNL group (81.18%) compared to the PTED group (63.89%) (P = 0.015).

CONCLUSION

CCNL is associated with better surgical efficiency, faster recovery, and superior pain relief and lumbar function recovery compared to PTED in the treatment of lumbar disc herniation. Age, disease duration, and preoperative VAS and ODI scores are independent prognostic factors for CCNL outcomes. This combined model effectively predicts the risk of poor postoperative outcomes.