Introduction: Lumbar disc herniation (LDH) is one of the most common diseases of the lumbar spine. LDH is generally treated with conservative treatment, and surgery is often required in cases refractory to prolonged conservative treatment. Recently, chemonucleolysis with condoliase has been widely used in Japan as a newer less-invasive intermediate treatment for LDH between conservative treatment and surgery. Although condoliase administration is considered an effective treatment in patients with LDH, favorable prognostic factors recommending the treatment are still unclear. The purpose of this study is to investigate clinical characteristics indicating the effect of condoliase therapy in patients with LDH.
Patients and Methods: The patients with LDH who received chemonucleolysis using condoliase at our institution between March 2020 and July 2024 were retrospectively reviewed. All patients had unilateral leg pain and no improvement after conservative therapy for 4 weeks or more. Condoliase was dissolved in 1.2ml saline to prepare a 1.25 U/mL solution. Under fluoroscopic guidance, a single 1mL of condoliase was injected into the intervertebral disc using a 22-gauge disc puncture needle, with the patient placed in prone position. The numeric rating scale (NRS) for leg pain was measured at baseline and at 3 months after the treatment. Patients who had an improvement of 3 points or more for leg pain on the NRS and did not require surgery was defined as having effective condoliase therapy. The following demographic and clinical data were extracted from medical record: age, gender, herniation level and the location of disc herniation.
Results: A total of 59 patients underwent chemonucleolysis with condoliase for LDH. All patients had more than 5 points for leg pain on the NRS at baseline. The mean NRS score at baseline was 8.0 ± 1.6. Condoliase was effective in 46 patients (78.0%). 6 patients (10.2%) required surgery within 3 months after condoliase treatment. The mean age at the time of condoliase treatment was 62.6 ± 18.6 years (6 patients at 20-39 years, 19 at 40-59 years, 22 at 60-79 years and 12 at 80 years or over). The very elderly patients (80 years or over) showed better improvement after the treatment (50.0% effective at 20-39 years, 84.2% at 40-59 years, 72.7% at 60-79 years and 91.7% at 80 years or over). 34 were males and 25 were females. Effective condoliase therapy had no differences between genders (76.5% males vs 80.0% females). The herniation levels were as follows: 6 at L2/3, 15 at L3/4, 33 at L4/5, and 5 at L5/S. Condoliase effect showed no differences between the herniation levels (66.7% at L2/3, 86.7% at L3/4, 78.8% at L4/5, and 60.0% at L5/S). Regarding the location of disc herniation, 11 patients had lateral (foraminal and extraforaminal) LDH and 48 had intracanal LDH. The responder rate was higher in lateral type than in intracanal type (90.9% vs 75.0%).
Conclusion: This study showed that condoliase injection could improve unilateral leg pain in patients with LDH. Especially the patients over 80 years and/or with lateral LDH should be recommended to receive condoliase therapy.