Uematsu Masato, Tamai Koji, Kato Minori, Toyoda Hiromitsu, Suzuki Akinobu, Takahashi Shinji, Sawada Yuta, Iwamae Masayoshi, Okamura Yuki, Kobayashi Yuto, Taniwaki Hiroshi, Kinoshita Yuki, Nakamura Hiroaki, Terai Hidetomi
Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Global Spine J. 2025 Sep 6:21925682251377726. doi: 10.1177/21925682251377726.
Study DesignRetrospective cohort study.ObjectiveCondoliase is a chemonucleolysis for lumbar disc herniation (LDH) that enzymatically degrades herniated disc material with high specificity for chondroitin sulfate and hyaluronic acid. Few studies have compared condoliase treatment with surgical treatments. We compared the clinical outcomes of condoliase treatment and minimally invasive discectomy.MethodsPatients who received condoliase treatment or minimally invasive discectomy at single institution were included. Propensity score matching was performed to adjust for age and sex. We included 146 patients with LDH (73 per group). The Japan Orthopaedic Association (JOA) score, visual analog scale (VAS) for leg pain, and disc height and degeneration were assessed at baseline and 2 weeks, 3 months, and 1 year after treatment.ResultsThe JOA score and leg pain VAS improved significantly over time ( < .001, Friedman's test). Two weeks after treatment, a marked improvement in JOA score and leg pain VAS was observed in the surgery group compared with the condoliase group ( < .001, mixed-effects model). However, 3 months and 1 year after treatment, the differences were not significant. In contrast, disc height reduction was significantly greater in the condoliase group than in the surgery group at 3 months and 1 year after treatment ( < .001, mixed-effects model). Condoliase treatment was identified as an independent risk factor for progression of disc degeneration (odds ratio, 23.60; = .001, logistic regression analysis).ConclusionCondoliase treatment demonstrated mid-term efficacy comparable to surgical treatment; however, it required more time for pain relief and was potentially associated with progression of disc degeneration.
研究设计
回顾性队列研究。
目的
康多裂解酶是一种用于腰椎间盘突出症（LDH）的化学髓核溶解剂，它能以对硫酸软骨素和透明质酸的高特异性酶解突出的椎间盘物质。很少有研究将康多裂解酶治疗与手术治疗进行比较。我们比较了康多裂解酶治疗和微创椎间盘切除术的临床疗效。
方法
纳入在单一机构接受康多裂解酶治疗或微创椎间盘切除术的患者。进行倾向得分匹配以调整年龄和性别。我们纳入了146例腰椎间盘突出症患者（每组73例）。在基线以及治疗后2周、3个月和1年评估日本骨科协会（JOA）评分、腿痛视觉模拟量表（VAS）以及椎间盘高度和退变情况。
结果
JOA评分和腿痛VAS随时间显著改善（<0.001，Friedman检验）。治疗后2周，手术组的JOA评分和腿痛VAS较康多裂解酶组有显著改善（<0.001，混合效应模型）。然而，治疗后3个月和1年，差异不显著。相比之下，治疗后3个月和1年，康多裂解酶组的椎间盘高度降低明显大于手术组（<0.001，混合效应模型）。康多裂解酶治疗被确定为椎间盘退变进展的独立危险因素（优势比，23.60；P = 0.001，逻辑回归分析）。
结论
康多裂解酶治疗显示出与手术治疗相当的中期疗效；然而，其疼痛缓解所需时间更长，并且可能与椎间盘退变进展有关。
