Fujimoto Kazuhiro, Suzuki Hidenori, Nishida Norihiro, Funaba Masahiro, Ichihara Yusuke, Tanaka Issei, Imajo Yasuaki, Yamamoto Manabu, Sakai Takashi
Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan; Department of Orthopedic Surgery, Japan Community Health Care Organization Tokuyama Central Hospital, Shunan, Yamaguchi, Japan.
Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
J Orthop Sci. 2025 Aug 12. doi: 10.1016/j.jos.2025.07.010.
Few studies have investigated factors associated with lumbar disc herniation (LDH) reduction and signal intensity changes after condoliase therapy. The aim of study is to investigate pre- and post-injection factors for hernia reduction and signal intensity changes on magnetic resonance images (MRI) after condoliase therapy in cases of LDH.
This retrospective, double-center study examined patients with unilateral leg pain caused by LDH who received condoliase therapy between August 2018 and July 2024. Patients were divided into three groups based on post-MRI: Group R: Hernia reduction; Group C: No hernia reduction and a signal intensity change; Group N: No hernia reduction or signal intensity change. Sex, age, the body mass index, duration of symptoms, herniation level, neurological and radiographic findings, the visual analog scale (VAS) score for leg pain, and the Oswestry disability index were examined in the three groups.
Subjects included 128 males and 84 females with a mean age of 50.6 years, mean BMI of 23.2, and mean duration of symptoms of 5.6 months. The duration of symptoms was shorter in group R than in group N (p = 0.02). Surgery after condoliase therapy was more frequent and improvements in VAS were fewer in group N than in the other two groups (both p < 0.01). The high intensity zone (HIZ) of hernia was more frequent in group R than in the other two groups (p < 0.01).
The present study revealed that patients with hernia reduction had a shorter duration of symptoms, more frequent HIZ of herniation, and pain relief early after condoliase therapy. Furthermore, approximately 50 % of cases without hernia reduction showed signal intensity changes within the herniation. These cases also had a shorter duration of symptoms and achieved pain relief after condoliase therapy.
很少有研究调查胶原酶治疗后腰椎间盘突出症（LDH）缩小及信号强度变化的相关因素。本研究的目的是调查LDH患者在胶原酶治疗后，磁共振成像（MRI）上疝缩小及信号强度变化的注射前后因素。
这项回顾性、双中心研究检查了2018年8月至2024年7月期间因LDH接受胶原酶治疗的单侧腿痛患者。根据MRI检查结果将患者分为三组：R组：疝缩小；C组：疝未缩小但信号强度改变；N组：疝未缩小且信号强度未改变。对三组患者的性别、年龄、体重指数、症状持续时间、突出水平、神经学和影像学表现、腿痛的视觉模拟量表（VAS）评分以及Oswestry功能障碍指数进行了检查。
受试者包括128名男性和84名女性，平均年龄50.6岁，平均BMI为23.2，平均症状持续时间为5.6个月。R组的症状持续时间比N组短（p = 0.02）。胶原酶治疗后N组手术更频繁，且与其他两组相比VAS改善更少（均p < 0.01）。R组疝的高强度区（HIZ）比其他两组更常见（p < 0.01）。
本研究表明，疝缩小的患者症状持续时间较短，疝的HIZ更常见，且在胶原酶治疗后早期疼痛缓解。此外，约50%疝未缩小的病例在突出物内出现信号强度变化。这些病例症状持续时间也较短，且在胶原酶治疗后实现了疼痛缓解。
